Comparison of Different Furosemide Regimens in the Treatment of Acute Heart Failure: A Meta-Analysis

Youpan Huang; Feijie Guo; Daori Chen; Haiman Lin; Jian Huang

doi:10.1155/2022/4627826

August 18, 2022Computational and Mathematical Methods in MedicineOpen Access

Comparison of Different Furosemide Regimens in the Treatment of Acute Heart Failure: A Meta-Analysis

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Why the study?

The study was conducted to compare the effects of different dosing schemes of furosemide on acute heart failure.

Does continuous administration of furosemide improve diuresis and clinical outcomes compared to intermittent administration in patients with acute heart failure?

Structured PICO

Does continuous administration of furosemide improve diuresis and clinical outcomes compared to intermittent administration in patients with acute heart failure?

P

Population

10 studies pooling 775 patients with acute heart failure (AHF)

I

Intervention

Continuous administration of furosemide

C

Comparator

Intermittent administration of furosemide

O

Outcome

Overall weight loss, 24-hour urine volume, length of hospital stay, 24-hour brain natriuretic peptide (BNP) level change, and all-cause mortality

Continuous infusion of furosemide provides superior short-term diuresis (greater weight loss and 24-hour urine volume) compared to intermittent boluses in acute heart failure, though without a significant impact on mortality or length of stay.

Implication

Continuous furosemide infusion enhances diuresis and weight loss in AHF; extends pooled RCT evidence supporting regimen optimization.

Abstract

Background. To compare the effects of different dosing schemes of furosemide on acute heart failure (AHF). Methods. Literature that compared the efficacy of continuous and intermittent administration of furosemide in AHF patients was retrieved from PubMed, Embase, the Cochrane Library, and ISI Web of Science from inception to May 2022. The primary endpoints included overall weight loss, 24-hour urine volume, length of hospital stay, 24-hour brain natriuretic peptide (BNP) level change, and all-cause mortality. The RevmMan5.4 software was used to analyze the extracted data. Results. A total of 10 studies with 775 patients, including 338 receiving continuous furosemide administration and 387 receiving intermittent furosemide administration, were included. The analysis results showed significant differences in weight loss ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>MD</a:mtext> <a:mo>=</a:mo> <a:mn>1.08</a:mn> </a:math> , 95% CI (0.75~1.40), <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo><</c:mo> <c:mn>0.00001</c:mn> </c:math> ) and 24-hour urine volume (MD =335.23, 95% CI (140.98~529.47), <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.0007</e:mn> </e:math> ) between the 2 groups. There was no significant difference in terms of length of hospital stay ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>MD</g:mtext> <g:mo>=</g:mo> <g:mo>−</g:mo> <g:mn>0.71</g:mn> </g:math> , 95% CI (-2.74~1.31), <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>=</i:mo> <i:mn>0.49</i:mn> </i:math> ) and all-cause mortality ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mtext>RR</k:mtext> <k:mo>=</k:mo> <k:mn>1.59</k:mn> </k:math> , 95% CI (0.92~2.75), <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo>=</m:mo> <m:mn>0.10</m:mn> </m:math> ). Conclusions. Compared with intermittent administration, continuous infusion of furosemide had a significant effect on the 24-hour urine volume and total weight loss in patients with AHF.