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Continuous Versus Intermittent Loop Diuretics Step-by-Step Protocol in Acute Heart Failure (DIUR-AHF):

Gaetano Ruocco1,2, Andrea Salzano3,4,5, Sara Franceschi6

  • 1Cardiovascular Research Institute Maastricht Maastrict University Maastricht Netherlands.

Journal of the American Heart Association
|March 10, 2026
PubMed

Insights

High-dose loop diuretics in acute heart failure increase adverse events and reduce effectiveness. This contrasts with low-dose treatment, suggesting caution with high-dose strategies for better patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Loop diuretics are standard treatment for acute heart failure (AHF) congestion.
  • Optimal dosing and administration strategies remain unclear.

Purpose of the Study:

  • To compare intermittent versus continuous furosemide infusion.
  • To evaluate high-dose (HD) versus low-dose loop diuretics.
  • To assess effects on congestion, renal function, and clinical outcomes in AHF.

Main Methods:

  • Analysis of the DIUR-AHF study data.
  • 370 AHF patients received either continuous or intermittent IV loop diuretics for 72-120 hours.
  • HD defined as >120 mg/day; outcomes assessed over 6-month follow-up.

Main Results:

  • HD loop diuretics showed similar congestion relief but reduced diuretic efficiency compared to low-dose.
  • HD group experienced significantly more adverse events (55% vs 20%).
  • Multivariable analysis linked HD treatment to poorer postdischarge outcomes (HR 1.95).

Conclusions:

  • High-dose loop diuretics in AHF increase adverse event risk and decrease diuretic response.
  • Findings align with previous research on HD diuretics and prognosis in chronic heart failure.
  • Further research needed on loop diuretic response with other decongestive therapies.
Abstract

Keywords:
acute heart failurecongestionloop diureticsmanagement

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