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

Abstract Objectives 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 consecut...

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Bibliographic Details
Published in:JACC. Heart failure 2016, Vol.4 (1), p.1-8
Main Authors: Buckley, Leo F., PharmD, Carter, Danielle M., PharmD, Matta, Lina, PharmD, MPH, Cheng, Judy W., PharmD, MPH, Stevens, Craig, PharmD, Belenkiy, Roman M., PharmD, Burpee, Laura J., NP, Young, Michelle A., NP, Weiffenbach, Cynthia S., RN, Smallwood, Jennifer A., MPH, Stevenson, Lynne W., MD, Desai, Akshay S., MD, MPH
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Ambulatory Care - methods
ambulatory treatment
Cardiac Volume - physiology
Cardiovascular
Dose-Response Relationship, Drug
Female
Furosemide - administration & dosage
heart failure
Heart Failure - drug therapy
Humans
Hyperemia - drug therapy
Infusions, Intravenous
loop diuretics
Male
Middle Aged
Patient Care Team
Sodium Potassium Chloride Symporter Inhibitors - administration & dosage
Stroke Volume - physiology
Treatment Outcome
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Summary:Abstract Objectives 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 (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.
ISSN:2213-1779
2213-1787
DOI:10.1016/j.jchf.2015.06.017