Key result
High-dose furosemide did not worsen creatinine at 72 hours in HFrEF (MD -0.05 mg/dL; P=0.23) but significantly increased creatinine in HFpEF (MD 0.16 mg/dL; P=0.03) compared with low-dose therapy.
Why the study?
HFrEF and HFpEF have distinct haemodynamic characteristics in acute heart failure, prompting an evaluation of their differential response to aggressive diuresis.
Does a high-dose furosemide strategy affect renal function and clinical outcomes differently in acute heart failure patients with HFrEF versus HFpEF?
RCT (n=300)
Does a high-dose furosemide strategy affect renal function and clinical outcomes differently in acute heart failure patients with HFrEF versus HFpEF?
Mean Difference: -0.05 (95% CI -0.14–0.03)
p-value: p=0.23
Aggressive diuresis with high-dose furosemide in acute heart failure appears beneficial in HFrEF but may worsen renal function without clinical benefit in HFpEF.
May warrant caution with aggressive diuresis in acute HFpEF; leaves open phenotype-specific strategies pending prospective trials.
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He et al. (2021) conducted an RCT in Acute heart failure (n=300). High-dose furosemide strategy vs. Low-dose furosemide strategy was evaluated on Change in creatinine at 72 h in HFrEF (MD -0.05, 95% CI -0.14 to 0.03, p=0.23). High-dose furosemide did not worsen creatinine at 72 hours in HFrEF (MD -0.05 mg/dL; P=0.23) but significantly increased creatinine in HFpEF (MD 0.16 mg/dL; P=0.03) compared with low-dose therapy.
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