Diuretic Strategies in Patients With Acute Decompesated Heart
Transcript of Diuretic Strategies in Patients With Acute Decompesated Heart
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NEJM
Diuretic strategies in patients with
acute decompesated heart failure
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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.
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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 patients previous oral dose) or a high dose
(2.5 times the previousoral dose).
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Conclusions
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Bolus vs countinuous infusion
There was no significant difference between thetwo treatment groups in the primary efficacy end
point of patient-reported global assessment of
symptoms (mean AUC, 42361440 with boluses
and 43731404 with continuous infusion; P =0.47) (Fig. 1). There was also no significant
between-group difference in the primary safety
end point of the change in serum creatinine level
from baseline to 72 hours (mean change increatinine level, 0.050.3 mg per deciliter
[4.426.5 mol per liter] with boluses and
0.070.3 mg per deciliter [6.226.5 mol per liter]
with continuous infusion; P = 0.45)
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Oral rute
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There was a nonsignificant trend toward greaterimprovement in the primary efficacy end point in
the high-dose group than in the low-dose group
(mean AUC, 44301401 vs. 41711436; P =
0.06) (Fig. 1). There was no significant differencebetween these two treatment groups in the
between the bolus group and the
continuousinfusion group in the proportion of
patients with serious adverse events (44% ineach group, P = 0.92).
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The mean change in the serum creatinine level
over
the course of the 72-hour.
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Conclusions
In conclusion, among patients with acutedecompensated heart failure and moderate-to-
high baseline diuretic requirements, there were
no significant differences in the patients global
assessment of symptoms or in changes frombaseline renal function with either bolus as
compared with continuous infusion of intravenous
furosemide or with a low-dose strategy as
compared with a highdose strategy.
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