Continuous Infusion and Sequential Nephron Blockade Versus Bolus Furosemide in Acute Heart Failure: A Systematic...

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Acute heart failure (AHF) is a major cause of hospitalization globally, characterized by congestion.
• Loop diuretics like furosemide are standard for decongestion, but optimal administration (infusion vs. bolus) is debated.
• Sequential nephron blockade strategies are emerging to address diuretic resistance in AHF.

Purpose of the Study:

• To compare continuous infusion versus bolus furosemide in AHF.
• To evaluate the efficacy and safety of adjunctive sequential nephron blockade (SGLT2 inhibitors, thiazides, acetazolamide) with loop diuretics in AHF.

Main Methods:

• Systematic literature search (2021-2025) in major databases.
• Included randomized controlled trials (RCTs) and prospective observational studies.
• Assessed risk of bias using RoB 2 and ROBINS-I tools; performed narrative synthesis.

Main Results:

• Continuous furosemide infusion improved urine output and weight loss but not clinical outcomes, with increased renal injury risk.
• SGLT2 inhibitors enhanced diuresis safely with a trend toward lower mortality.
• Thiazides and acetazolamide improved decongestion but showed no mortality benefit and potential safety concerns (thiazides).

Conclusions:

• No single decongestive strategy is universally superior due to heterogeneity.
• Continuous furosemide infusion offers diuresis but lacks consistent clinical benefit and carries renal risks.
• SGLT2 inhibitors are a promising adjunct, while thiazides require caution; individualized treatment is key.