Comparison of three diuretic treatment strategies for patients with acute decompensated heart failure

Herz. 2015 Dec;40(8):1115-20. doi: 10.1007/s00059-015-4327-y. Epub 2015 Jul 2.


Background: There are few prospective data available for establishing a standard diuretic administration regimen for patients with acute decompensated heart failure (ADHF). We aimed to assess the safety and efficacy of three regimens of furosemide administration in patients with ADHF with regard to diuresis, renal functions, and in-hospital outcomes.

Methods: A total of 43 patients who presented with ADHF were randomized into three groups: (a) continuous infusion (cIV) of 160 mg furosemide for 16 h/day (n = 15); (b) bolus injections (bI) of 80 mg furosemide twice a day (n = 14); (c) and administration of 160 mg furosemide plus hypertonic saline solution (HSS) as an infusion for 30 min once a day (n = 14). All regimens were continued for 48 h. Study endpoints were negative fluid balance assessed by loss of body weight, change in the serum creatinine (baseline to 48 h and baseline to compensated state), and length of hospitalization.

Results: There was no significant difference in the mean change in serum creatinine level at the end of 48 h between groups (p = 0.08). There was also no significant difference among groups regarding loss of body weight (p = 0.66). A significantly shorter hospitalization was observed in patients treated with HSS compared with the other groups (cIV group 6.6 ± 3.4 days vs. bI group 7.9 ± 4.1 days vs. HSS group 3.7 ± 1.3 days; p < 0.01).

Conclusion: All three furosemide regimens have similar renal safety and efficacy measures. However, administration of furosemide plus HSS may be the preferred diuretic strategy because of its shorter hospital stay.

Keywords: Acute heart failure syndrome; Diuretic therapy; Furosemide; Hospitalization; Renal safety profile.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Administration, Oral
  • Adrenergic beta-Antagonists / administration & dosage
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Diuretics / administration & dosage*
  • Female
  • Furosemide / administration & dosage*
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy*
  • Heart Failure / prevention & control*
  • Humans
  • Male
  • Mineralocorticoid Receptor Antagonists / administration & dosage
  • Prospective Studies
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Diuretics
  • Mineralocorticoid Receptor Antagonists
  • Furosemide