Why the study?
Intravenous diuretics are a cornerstone of acute heart failure treatment, but the optimal initial dose remains unclear.
Does the initial intravenous diuretic dose (below, standard, or above guideline recommendations) affect 60-day mortality, diuretic response, and length of hospital stay in patients with acute decompensated heart failure?
Observational (n=1,093)
Yes
Does the initial intravenous diuretic dose (below, standard, or above guideline recommendations) affect 60-day mortality, diuretic response, and length of hospital stay in patients with acute decompensated heart failure?
Adhering to guideline-recommended initial intravenous diuretic doses in acute heart failure optimizes outcomes by avoiding the increased mortality seen with higher doses and the prolonged hospital stays seen with lower doses.
Answers are grounded in this paper and cite their sources.
May warrant caution with non-standard diuretic doses in acute HF; leaves open optimal strategies pending randomized confirmation.
Although intravenous diuretics is a cornerstone of acute heart failure treatment (AHF), its optimal initial dose is unclear. This is a post-hoc analysis of the REALITY-AHF, a prospective multicentre observational registry of AHF. The initial intravenous diuretic dose used in each patient was categorised into below, standard, or above the recommended dose groups according to guideline-recommended initial intravenous diuretic dose. The recommended dose was individualised based on the oral diuretic dose taken at admission. We compared the study endpoints, including 60-day mortality, diuretics response within six hours, and length of hospital stay (HS). Of 1,093 patients, 429, 558, and 106 were assigned to the Below, Standard, and Above groups, respectively. The diuretics response and HS were significantly greater in the Below group than in the Standard group after adjusting for covariates. Kaplan-Meier analysis indicated a significantly higher incidence of 60-day mortality in the Above group than the Standard group. This difference was retained after adjusting for other prognostic factors. Treatment with a lower than guideline-recommended intravenous diuretic dose was associated with longer HS, whereas above the guideline-recommended dose was associated with a higher 60-day mortality rate. Our results reconfirm that the guideline-recommended initial intravenous diuretic dose is feasible for AHF.
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Yoshioka et al. (2021) conducted an observational in Acute decompensated heart failure (n=1,093). Initial intravenous furosemide dose above guideline recommendation vs. Standard guideline-recommended dose was evaluated on All-cause 60-day mortality (HR 3.90, 95% CI 1.71-8.91, p=0.001).
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