High-dose intravenous furosemide (>1 mg/kg) did not significantly affect in-hospital mortality compared to low-dose therapy in acute heart failure (15% vs 13%; P=0.4).
Observational (n=4,953)
Yes
Does high-dose intravenous furosemide influence in-hospital mortality in patients with acute heart failure compared to low-dose furosemide?
High-dose intravenous loop diuretics do not appear to worsen short-term in-hospital mortality in acute heart failure when adjusting for confounding variables.
Absolute Event Rate: 15% vs 13%
p-value: p=0.4
AIMS: Loop diuretics are recommended to treat congestion in heart failure (HF), despite limited quality evidence. High-dose (HD) loop diuretics seem to worsen outcomes in chronic HF, though; data for acute HF are scarce, with equivocal results. METHODS AND RESULTS: The ALARM-HF study recorded in-hospital HF therapy in 4953 patients from nine countries. A post-hoc analysis was performed to determine if there was an interaction between intravenous (iv) bolus diuretic dosing and outcomes. Patients were classified as receiving high- or low-dose iv furosemide if their total initial 24 h dose was above (HD) or below low dose (LD) 1 mg/kg. Propensity scoring, matching an extensive list of variables, was performed. High-dose and LD patients were matched by propensity scores and outcomes determined. We identified 2460 LD and 848 HD patients, with overall in-hospital mortality of 9 and 13% (P= 0.002), respectively. After propensity matching, there were 506 patients in each subgroup, with the matched LD and HD cohorts having similar mortality (13 vs. 15%; P= 0.4). We further investigated in which subgroups of patients HD diuretics influenced mortality. Before matching, HD diuretics were associated with a greater risk of in-hospital death in some subgroups, including patients aged >80 years, those with an acute coronary syndrome, or with a left ventricular ejection fraction <40%. However, after propensity score matching, no association was found between diuretic dosing and death in any of the studied subgroups. CONCLUSIONS: In the initial management of acute HF, HD iv diuretics, per se, do not influence short-term mortality.
Yılmaz et al. (Mon,) conducted a observational in Acute Heart Failure (n=4,953). High-dose intravenous furosemide vs. Low-dose intravenous furosemide (<1 mg/kg) was evaluated on In-hospital mortality (p=0.4). High-dose intravenous furosemide (>1 mg/kg) did not significantly affect in-hospital mortality compared to low-dose therapy in acute heart failure (15% vs 13%; P=0.4).