Aggressive diuresis for severe heart failure in the elderly.
OBJECTIVE
To determine the efficacy, safety, and economic benefit of continuous IV infusion of furosemide as a treatment modality for elderly patients with class IV heart failure.


METHODS
Prospective trial of consecutively admitted elderly patients > 65 years old with class IV heart failure.


METHODS
A single cardiovascular service in a university medical center.


METHODS
Seventeen male and female patients > 65 years old consecutively admitted to a cardiovascular service.


RESULTS
High-dose, continuous IV infusion of furosemide was successful in providing a 9- to 20-L diuresis in an average of 3.5 days without causing clinical complications or aberrations in blood chemistry. The length of stay was 2.3 days shorter than a contemporary group of class III and class IV elderly patients with heart failure managed on other medical services. The Medicare reimbursement for heart failure was $6,047. Patients receiving IV bolus diuretic therapy incurred billing charges of $10,193, or a loss of $4,146 per patient to the hospital. Patients receiving diuretic infusion therapy incurred billing charges of $4,944. This was a difference of $5,249 per patient treated by continuous IV infusion compared to bolus therapy and a profit per Medicare patient of $1,103. Therefore, a $4,146 billing loss was converted to $1,103 profit.


CONCLUSIONS
IV furosemide infusion therapy for class IV heart failure in the elderly is a safe, effective, and economic mode of therapy.
Howard
P A
PA
Department of Pharmacy, University of Kansas Medical Center, Kansas City, KS 66160-7231, USA.
Dunn
M I
MI
D000368:Aged; D017046:Cost Savings; D004232:Diuretics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics; D011446:Prospective Studies; D013997:Time Factors
D004232:Diuretics; D005665:Furosemide