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Clinical effects and safety of different strategies for administering intravenous diuretics in acutely decompensated heart failure: a randomised clinical trial
  1. Pere Llorens1,
  2. Òscar Miró2,
  3. Pablo Herrero3,
  4. Francisco Javier Martín-Sánchez4,
  5. Javier Jacob5,
  6. Amparo Valero6,
  7. Héctor Alonso7,
  8. María José Pérez-Durá8,
  9. Antonio Noval9,
  10. José Juan Gil-Román3,
  11. Pedro Zapater10,
  12. Lucía Llanos10,
  13. Víctor Gil2,
  14. Rafel Perelló2
  1. 1Emergency Department and Short-Stay Unit, Hospital General Universitario de Alicante, Alicante, Spain
  2. 2Emergency Department, Hospital Clinic de Barcelona; ‘Emergencies: Processes and Pathologies’ Research Group, IDIBAPS, Barcelona, Spain
  3. 3Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
  4. 4Emergency Department, Hospital Clínico San Carlos de Madrid, Madrid, Spain
  5. 5Emergency Department, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
  6. 6Emergency Department, Hospital Dr Peset, Valencia, Spain
  7. 7Emergency Department, Hospital Marques de Valdecilla, Santander, Spain
  8. 8Emergency Department, Hospital la Fe, Valencia, Spain
  9. 9Emergency Department, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
  10. 10Clinical Pharmacology Unit, Hospital General Universitario de Alicante, Alicante, Spain
  1. Correspondence to Dr Pere Llorens, Emergency Department, Hospital General de Alicante, Pintor Baeza Street n° 12, Alicante 03010, Spain; llorens_ped{at}


Background The mainstay of treatment for acutely decompensated heart failure (ADHF) is intravenous diuretic therapy either as a bolus or via continuous infusion.

Objectives We evaluated the clinical effects and safety of three strategies of intravenous furosemide administration used in emergency departments (EDs) for ADHF.

Methods We performed a multicentre, randomised, parallel-group study. Patients with ADHF were randomised within 2 h of ED arrival to receive furosemide by continuous infusion (10 mg/h, group 1) or boluses (20 mg/6 h, group 2; or 20 mg/8 h, group 3). The primary end point was total diuresis, and secondary end points were dyspnoea, orthopnoea, extension of rales and peripheral oedema, blood pressure, respiratory and heart rates, and pulse oximetry, which were measured at arrival and 3, 6, 12 and 24 h after treatment onset. We also measured serum creatinine, sodium and potassium levels at arrival and after 24 h.

Results Group 1 patients (n=36) showed greater 24 h diuresis (3705 mL) than those in groups 2 (n=37) and 3 (n=36) (3093 and 2670 mL, respectively; p<0.01), and this greater diuretic effect was observed earlier. However, no differences were observed among groups in the nine secondary clinical end points evaluated. Creatinine deterioration developed in 15.6% of patients, hyponatraemia in 9.2%, and hypokalaemia in 19.3%, with the only difference among groups observed in hypokalaemia (group 1, 36.3%; group 2, 13.5%; group 3, 8.3%; p<0.01).

Conclusions In patients with ADHF attending the ED, boluses of furosemide have a smaller diuretic effect but provide similar clinical relief, similar preservation of renal function, and a lower incidence of hypokalaemia than continuous infusion.

Trial registration number This randomised trial was registered in the European Clinical Trial Database (EudraCT) with the reference number 2008-004488-20.

  • treatment
  • heart failure
  • emergency departments

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