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

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 resu...

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Published in:International journal of cardiology 2014-03, Vol.172 (1), p.115-121
Main Authors: Triposkiadis, Filippos K, Butler, Javed, Karayannis, Georgios, Starling, Randall C, Filippatos, Gerasimos, Wolski, Kathy, Parissis, John, Parisis, Charalabos, Rovithis, Dimitrios, Koutrakis, Konstantinos, Skoularigis, John, Antoniou, Christos-Konstantinos, Chrysohoou, Christina, Pitsavos, Christos, Stefanadis, Christodoulos, Nastas, John, Tsaknakis, Themistoklis, Mantziari, Lilian, Giannakoulas, Georgios, Karvounis, Haralambos, Kalogeropoulos, Andreas P, Giamouzis, Gregory
Format: Article
Language:English
Subjects:
Acute heart failure
Aged
Aged, 80 and over
Biological and medical sciences
Blood Pressure - drug effects
Cardiology. Vascular system
Cardiotonic Agents - administration & dosage
Cardiotonic Agents - adverse effects
Cardiovascular
Diuretics - administration & dosage
Diuretics - adverse effects
Dopamine
Dopamine - administration & dosage
Dopamine - adverse effects
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Furosemide
Furosemide - administration & dosage
Furosemide - adverse effects
Heart
Heart Failure - drug therapy
Heart Failure - mortality
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Heart Rate - drug effects
Hemodynamics
Hospital Mortality
Humans
Kidney - drug effects
Male
Medical sciences
Patient Readmission
Single-Blind Method
Stroke Volume - drug effects
Treatment Outcome
Urine
Worsening renal function
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Summary: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, 20 mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n = 56, 5 mg/h and 5 μg kg − 1 min − 1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/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) ≥ 0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h 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.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2013.12.276