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THURSDAY, March 3 (HealthDay News) -- The responses of patients with acute decompensated heart failure to loop diuretics don't appear to differ between groups administered the agent by bolus or continuous infusion, or at a high or low dose, according to research published in the March 3 issue of the New England Journal of Medicine.
G. Michael Felker, M.D., M.H.S., of the Duke University School of Medicine in Durham, N.C., and colleagues treated 308 patients with acute decompensated heart failure with furosemide by either a bolus or continuous infusion, and either a low dose (the patient's previous dose) or high dose (2.5 times the previous oral dose).
The researchers found no significant difference in the patients' global assessment of symptoms or in the mean change in serum creatinine levels whether patients received the treatment via bolus or continuous infusion. Patients in the high-dose group experienced a nonsignificant trend toward improved symptoms, but no significant difference in creatinine levels. The high-dose strategy was related to greater diuresis and better outcomes in some secondary measures but also with transient worsening of renal function.
"These findings are not consistent with prior, much smaller studies suggesting that continuous infusion, as compared with boluses, is associated with a lesser degree of renal dysfunction and greater diuresis. One possible explanation for the absence of a significant difference in outcomes between boluses and continuous infusion in our study is the use of a continuous placebo infusion in the patients assigned to boluses; this feature of the study design may have served to increase the time the patients were supine, a position that has been shown to enhance diuresis," the authors write.
Several authors disclosed financial ties to pharmaceutical and/or medical device companies.
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