Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) trial

Int J Cardiol. 2014 Mar 1;172(1):115-21. doi: 10.1016/j.ijcard.2013.12.276. Epub 2014 Jan 10.

Abstract

Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.

Methods and results: 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5 μg kg(-1)min(-1) respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted.

Conclusions: In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.

Trial registration: ClinicalTrials.gov NCT01060293.

Keywords: Acute heart failure; Dopamine; Furosemide; Worsening renal function.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Pressure / drug effects
  • Cardiotonic Agents / administration & dosage*
  • Cardiotonic Agents / adverse effects
  • Diuretics / administration & dosage*
  • Diuretics / adverse effects
  • Dopamine / administration & dosage*
  • Dopamine / adverse effects
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Furosemide / administration & dosage*
  • Furosemide / adverse effects
  • Heart Failure / drug therapy*
  • Heart Failure / mortality
  • Heart Rate / drug effects
  • Hemodynamics
  • Hospital Mortality
  • Humans
  • Kidney / drug effects
  • Male
  • Patient Readmission
  • Single-Blind Method
  • Stroke Volume / drug effects
  • Treatment Outcome
  • Urine

Substances

  • Cardiotonic Agents
  • Diuretics
  • Furosemide
  • Dopamine

Associated data

  • ClinicalTrials.gov/NCT01060293