Efficacy Comparison of Continuous versus Intermittent Furosemide Administration in Acute Heart Failure

Overview

This systematic review and meta-analysis of 22 RCTs evaluates the efficacy of continuous versus intermittent furosemide administration in acute heart failure. Continuous infusion was associated with improvements in freedom from congestion and weight loss, while no significant advantage was found for all-cause mortality.

Background

Acute heart failure (AHF) is a leading cause of hospitalization worldwide, with a significant burden on healthcare systems. The optimal administration strategy for loop diuretics, particularly furosemide, remains debated. Understanding the efficacy of different administration methods is essential.

Data Highlights

Key Findings

• The cIV arm showed improvements in freedom from congestion (RR: 1.42, p = 0.02).
• Intermittent infusion showed a numerical trend toward higher all-cause mortality (RR: 1.36, p = 0.08) without statistical significance.
• Continuous infusion resulted in greater weight loss compared to intermittent infusion.
• Continuous infusion was associated with higher 24-h urine volume and shorter length of hospital stay.
• Post-treatment BNP levels were lower in the cIV group.

Clinical Implications

The findings suggest that continuous furosemide infusion may provide better management of congestion and fluid overload in acute heart failure patients. Clinicians should consider the potential benefits of continuous infusion when developing treatment plans for patients with AHF.

Conclusion

Continuous furosemide infusion demonstrates advantages in managing acute heart failure in terms of congestion relief and weight loss, although no significant impact on long-term survival was observed.

Related Resources & Content

1. Author(s)/Org, Source, Year -- Title
2. Critical Care (Springer) — Protocolized natriuresis-guided diuretic therapy in acute heart failure: a systematic review and meta-analysis
3. Clinical Research in Cardiology — Impact of Sodium Intake Limitation on Chronic Heart Failure: A Systematic Review and Meta-Analysis
4. Pediatric Cardiology — Urine Output Following Furosemide Infusion in Infants Post-Cardiopulmonary Bypass as an Indicator of Acute Kidney Injury Risk
5. npj Digital Medicine — Comparative Effectiveness of Telemonitoring Approaches in Heart Failure: A Meta-Analysis of Patient Outcomes
6. 2024 ACC Expert Consensus Decision Pathway on Clinical Assessment, Management, and Trajectory of Patients Hospitalized With Heart Failure Focused Update
7. Diuretic Strategies in Patients with Acute Decompensated Heart Failure