Furosemide for AHF: similar outcomes with bolus vs continuous dosing

Takeaway

• For patients with acute heart failure (AHF) who take furosemide, this meta-analysis found greater urine output (UOP) and weight loss with continuous vs bolus infusion.
• Differences were of unclear clinical relevance, however.
• Authors: because of modest effect sizes, the choice between the 2 in patients with AHF is up to the clinician.

Why this matters

• Although diuresis has not been linked to survival benefit in this population, major societies continue to recommend it as a key AHF therapy.
• They do not specify whether to use a bolus or a continuous-infusion approach for furosemide dosing.

Key results

• Continuous vs bolus infusion:
  • UOP was greater in continuous group.
    • Weighted mean difference (WMD), 444.37 mL (95% CI, 196.23 to −692.51; P<.001).
  • Weight loss was also greater in continuous group.
    • WMD, 0.89 kg (95% CI, 0.04-1.75; P=.04).
  • No significant between-group differences in length of stay (LOS) or serum sodium, potassium, and creatinine.

Study design

• Meta-analysis of 10 randomised controlled trials (n=735).
• Outcomes: post-treatment daily UOP, weight, LOS, and serum sodium, potassium, and creatinine.
• Funding: None.

Limitations

• 5 studies nonblinded.
• Patient-centred outcomes (e.g., dyspnoea, mortality) and post-treatment natriuretic peptide were insufficiently or inconsistently reported and could not be analysed.