Ideal Initial Diuretic Dose In A Diuretic Naive Patient Admitted For Acute Decompensated Heart Failure

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.676-676
• Main Authors: Rundhawa, Gohar, Rehman, Aisha, Iyer, Karishma, Mumtaz, Salmaan
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.321

Currently, the European Society of Cardiology recommends at least 25 to 40 mg of intravenous furosemide in patients not previously on diuretics being treated for acute decompensated heart failure (ADHF). The aim of this study was to analyze the effects of different intravenous loop diuretic doses on 60-day outcomes, weight loss, and urine output in diuretic naïve patients hospitalized for ADHF. This was a multicenter retrospective study at a hospital center in Pennsylvania examining all patients admitted for ADHF between May 1, 2017 and January 1, 2020. Diuretic naive was defined as any patient without a documented home loop diuretic as a home medication. The cohort was subdivided into diuretic naive patients receiving less than 40 mg (low dose group), between 40 to 80 mg (intermediate group), and greater than 80 mg (high dose group). Worsening renal function was defined as a greater than 0.3 mg/dL change in creatinine. Diuretic failure was defined as an increase in intravenous diuretic dose after 48 hours. 449 patients were identified using the inclusion criteria. There were 95 patients in the low dose group, 298 in the intermediate dose group, and 55 in the high dose group. Higher diuretic doses were associated with increased weight loss and urine output (p < 0.05). Furthermore, there was a significant difference in urine output between the low, intermediate, and high dose groups: 1.26 L, 1.82 L, and 2.56 L (p < 0.05). There were no significant differences in creatinine change at 72 hours and discharge between the three groups. Lower initial hospital diuretic doses were strongly associated with mortality at 60 days (p < 0.05) and diuretic failure (p = 0.086). Diuretic naive patients may benefit from loop diuretic doses greater than 80 mg due to increased weight loss and urine output (p < 0.05) without a significant increase in creatinine at 72 hours and discharge. Furthermore, loop diuretic doses less than 40 mg may actually be suboptimal given the association with diuretic failure as well as mortality at 60 days. As a result, loop diuretic doses greater than 40 mg and even 80 mg should be considered in diuretic naive patients hospitalized for acute decompensated heart failure.