Aggressive diuresis for severe heart failure in the elderly

Chest. 2001 Mar;119(3):807-10. doi: 10.1378/chest.119.3.807.


Study objective: To determine the efficacy, safety, and economic benefit of continuous IV infusion of furosemide as a treatment modality for elderly patients with class IV heart failure.

Design: Prospective trial of consecutively admitted elderly patients > 65 years old with class IV heart failure.

Setting: A single cardiovascular service in a university medical center.

Patients: Seventeen male and female patients > 65 years old consecutively admitted to a cardiovascular service.

Results: High-dose, continuous IV infusion of furosemide was successful in providing a 9- to 20-L diuresis in an average of 3.5 days without causing clinical complications or aberrations in blood chemistry. The length of stay was 2.3 days shorter than a contemporary group of class III and class IV elderly patients with heart failure managed on other medical services. The Medicare reimbursement for heart failure was $6,047. Patients receiving IV bolus diuretic therapy incurred billing charges of $10,193, or a loss of $4,146 per patient to the hospital. Patients receiving diuretic infusion therapy incurred billing charges of $4,944. This was a difference of $5,249 per patient treated by continuous IV infusion compared to bolus therapy and a profit per Medicare patient of $1,103. Therefore, a $4,146 billing loss was converted to $1,103 profit.

Conclusion: IV furosemide infusion therapy for class IV heart failure in the elderly is a safe, effective, and economic mode of therapy.

MeSH terms

  • Aged
  • Cost Savings
  • Diuretics / administration & dosage
  • Diuretics / economics
  • Diuretics / therapeutic use*
  • Female
  • Furosemide / administration & dosage
  • Furosemide / economics
  • Furosemide / therapeutic use*
  • Heart Failure / drug therapy*
  • Heart Failure / economics*
  • Hospital Charges / statistics & numerical data*
  • Humans
  • Infusions, Intravenous
  • Length of Stay / economics*
  • Length of Stay / statistics & numerical data
  • Male
  • Medicare / economics
  • Prospective Studies
  • Time Factors


  • Diuretics
  • Furosemide