Intravenous Diuretic Therapy for the Management of Heart Failure and Volume Overload in a Multidisciplinary Outpatient Unit

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• 作者：Leo F. Buckley ; PharmD^&lowast ; ; ^{LBuckley2@vcu.edu" class="auth_mail" title="E-mail the corresponding author} ; Danielle M. Carter ; PharmD^&lowast ; ; Lina Matta ; PharmD ; MPH^&lowast ; ; Judy W. Cheng ; PharmD ; MPH^&dagger ; ; Craig Stevens ; PharmD^&lowast ; ; Roman M. Belenkiy ; PharmD^&lowast ; ; Laura J. Burpee ; NP^&Dagger ; ; Michelle A. Young ; NP^&Dagger ; ; Cynthia S. Weiffenbach ; RN^&Dagger ; ; Jennifer A. Smallwood ; MPH^&Dagger ; ; Lynne W. Stevenson ; MD^&Dagger ; ; Akshay S. Desai ; MD ; MPH^&Dagger ;
• 关键词：ambulatory treatment ; heart failure ; loop diuretics
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：4
• 期：1
• 页码：1-8
• 全文大小：541 K

文摘

This study sought to evaluate the effectiveness of intravenous (IV) diuretic treatment for volume management in heart failure (HF).

Background

Limited data exist regarding IV diuretics for the outpatient treatment of volume overload in HF patients.

Methods

We analyzed 60 consecutive patients with chronic HF and clinical evidence of worsening congestion who received a bolus and 3-h IV infusion of furosemide at an outpatient HF clinic. Diuretic dosing was derived from the maintenance oral loop diuretic dose with a standardized conversion algorithm. Outcomes included urine output during the visit, weight loss at 24 h, and hospitalization and mortality at 30 days. Safety outcomes included hypokalemia and worsening of renal function. Outcomes were analyzed across subgroups defined by maintenance diuretic dose and ejection fraction (EF).

Results

The median age of the cohort was 70 years (interquartile range [IQR]: 58 to 80 years), and the median daily loop diuretic dose was 240 mg (IQR: 80 to 800 mg) oral furosemide or equivalent. Twenty-six patients (43.3%) were women, and 36 (60%) had an EF ≤45%. For the entire cohort, the median urine output and 24-h weight loss were 1.1 l (IQR: 0.6 to 1.4 l) and 1.1 kg (IQR: 0.2 to 1.9 kg), respectively. Outcomes were similar across patients with varying maintenance diuretic doses (<40 mg, 40 to 160 mg, 160 to 300 mg, or >300 mg of furosemide or equivalent) and in patients with reduced or preserved EF. Transient worsening of renal function and hypokalemia occurred in 10 patients (8.9%) and 4 patients (3.5%). Although hospitalization was reported as imminent for 28 patients (52.8%), the observed rate of all-cause hospitalization was 31.7% at 30 days with no deaths.

Conclusions

Short courses of IV diuretics for volume management in patients with HF were safe and associated with significant urine output and weight loss across a wide range of maintenance diuretic doses and EF. This strategy may provide an alternative to hospitalization for the management of selected HF patients.