Diuretic strategies in patients with acute decompensated heart failure

G. Michael Felker, Kerry L. Lee, David A. Bull, Margaret May Redfield, Lynne W. Stevenson, Steven R. Goldsmith, Martin M. LeWinter, Anita Deswal, Jean L. Rouleau, Elizabeth O. Ofili, Kevin J. Anstrom, Adrian F. Hernandez, Steven E. McNulty, Eric J. Velazquez, Abdallah G. Kfoury, Horng Haur Chen, Michael M. Givertz, Marc J. Semigran, Bradley A. Bart, Alice M. MascetteEugene Braunwald, Christopher M. O'Connor

Research output: Contribution to journalArticle

856 Citations (Scopus)

Abstract

BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours. RESULTS: In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P = 0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 ?mol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P = 0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P = 0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P = 0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function. CONCLUSIONS: Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose.

Original languageEnglish (US)
Pages (from-to)797-805
Number of pages9
JournalNew England Journal of Medicine
Volume364
Issue number9
DOIs
StatePublished - Mar 3 2011

Fingerprint

Diuretics
Heart Failure
Symptom Assessment
Area Under Curve
Creatinine
Sodium Potassium Chloride Symporter Inhibitors
Kidney
Diuresis
Furosemide
Visual Analog Scale
Therapeutics
Serum

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., Stevenson, L. W., Goldsmith, S. R., ... O'Connor, C. M. (2011). Diuretic strategies in patients with acute decompensated heart failure. New England Journal of Medicine, 364(9), 797-805. https://doi.org/10.1056/NEJMoa1005419

Diuretic strategies in patients with acute decompensated heart failure. / Felker, G. Michael; Lee, Kerry L.; Bull, David A.; Redfield, Margaret May; Stevenson, Lynne W.; Goldsmith, Steven R.; LeWinter, Martin M.; Deswal, Anita; Rouleau, Jean L.; Ofili, Elizabeth O.; Anstrom, Kevin J.; Hernandez, Adrian F.; McNulty, Steven E.; Velazquez, Eric J.; Kfoury, Abdallah G.; Chen, Horng Haur; Givertz, Michael M.; Semigran, Marc J.; Bart, Bradley A.; Mascette, Alice M.; Braunwald, Eugene; O'Connor, Christopher M.

In: New England Journal of Medicine, Vol. 364, No. 9, 03.03.2011, p. 797-805.

Research output: Contribution to journalArticle

Felker, GM, Lee, KL, Bull, DA, Redfield, MM, Stevenson, LW, Goldsmith, SR, LeWinter, MM, Deswal, A, Rouleau, JL, Ofili, EO, Anstrom, KJ, Hernandez, AF, McNulty, SE, Velazquez, EJ, Kfoury, AG, Chen, HH, Givertz, MM, Semigran, MJ, Bart, BA, Mascette, AM, Braunwald, E & O'Connor, CM 2011, 'Diuretic strategies in patients with acute decompensated heart failure', New England Journal of Medicine, vol. 364, no. 9, pp. 797-805. https://doi.org/10.1056/NEJMoa1005419
Felker, G. Michael ; Lee, Kerry L. ; Bull, David A. ; Redfield, Margaret May ; Stevenson, Lynne W. ; Goldsmith, Steven R. ; LeWinter, Martin M. ; Deswal, Anita ; Rouleau, Jean L. ; Ofili, Elizabeth O. ; Anstrom, Kevin J. ; Hernandez, Adrian F. ; McNulty, Steven E. ; Velazquez, Eric J. ; Kfoury, Abdallah G. ; Chen, Horng Haur ; Givertz, Michael M. ; Semigran, Marc J. ; Bart, Bradley A. ; Mascette, Alice M. ; Braunwald, Eugene ; O'Connor, Christopher M. / Diuretic strategies in patients with acute decompensated heart failure. In: New England Journal of Medicine. 2011 ; Vol. 364, No. 9. pp. 797-805.
@article{561066731310493e9e0c7ac3eff2f2c4,
title = "Diuretic strategies in patients with acute decompensated heart failure",
abstract = "BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours. RESULTS: In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P = 0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 ?mol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P = 0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P = 0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P = 0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function. CONCLUSIONS: Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose.",
author = "Felker, {G. Michael} and Lee, {Kerry L.} and Bull, {David A.} and Redfield, {Margaret May} and Stevenson, {Lynne W.} and Goldsmith, {Steven R.} and LeWinter, {Martin M.} and Anita Deswal and Rouleau, {Jean L.} and Ofili, {Elizabeth O.} and Anstrom, {Kevin J.} and Hernandez, {Adrian F.} and McNulty, {Steven E.} and Velazquez, {Eric J.} and Kfoury, {Abdallah G.} and Chen, {Horng Haur} and Givertz, {Michael M.} and Semigran, {Marc J.} and Bart, {Bradley A.} and Mascette, {Alice M.} and Eugene Braunwald and O'Connor, {Christopher M.}",
year = "2011",
month = "3",
day = "3",
doi = "10.1056/NEJMoa1005419",
language = "English (US)",
volume = "364",
pages = "797--805",
journal = "New England Journal of Medicine",
issn = "1533-4406",
publisher = "Massachussetts Medical Society",
number = "9",

}

TY - JOUR

T1 - Diuretic strategies in patients with acute decompensated heart failure

AU - Felker, G. Michael

AU - Lee, Kerry L.

AU - Bull, David A.

AU - Redfield, Margaret May

AU - Stevenson, Lynne W.

AU - Goldsmith, Steven R.

AU - LeWinter, Martin M.

AU - Deswal, Anita

AU - Rouleau, Jean L.

AU - Ofili, Elizabeth O.

AU - Anstrom, Kevin J.

AU - Hernandez, Adrian F.

AU - McNulty, Steven E.

AU - Velazquez, Eric J.

AU - Kfoury, Abdallah G.

AU - Chen, Horng Haur

AU - Givertz, Michael M.

AU - Semigran, Marc J.

AU - Bart, Bradley A.

AU - Mascette, Alice M.

AU - Braunwald, Eugene

AU - O'Connor, Christopher M.

PY - 2011/3/3

Y1 - 2011/3/3

N2 - BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours. RESULTS: In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P = 0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 ?mol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P = 0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P = 0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P = 0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function. CONCLUSIONS: Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose.

AB - BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours. RESULTS: In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P = 0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 ?mol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P = 0.45). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430±1401 vs. 4171±1436; P = 0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P = 0.21). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function. CONCLUSIONS: Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose.

UR - http://www.scopus.com/inward/record.url?scp=79952260198&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952260198&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa1005419

DO - 10.1056/NEJMoa1005419

M3 - Article

C2 - 21366472

AN - SCOPUS:79952260198

VL - 364

SP - 797

EP - 805

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 1533-4406

IS - 9

ER -