Clinical inquiries. Does furosemide decrease morbidity or mortality for patients with diastolic or systolic dysfunction?
No large-scale randomized, placebo-controlled trials evaluate furosemide's effect on mortality and long-term morbidity in diastolic or systolic dysfunction. In short-term studies, furosemide reduces edema, reduces hospitalizations, and improves exercise capacity in the setting of systolic dysfunction (strength of recommendation [SOR]: B, based upon low-quality randomized controlled trials). Furosemide and other diuretics reduce symptomatic volume overload in diastolic and systolic dysfunction (SOR: C, based on expert opinion). There is potential morbidity with the use of high-dose loop diuretics (volume contraction, electrolyte disturbances, and neuroendocrine activation). Use of high-dose loop diuretics for systolic dysfunction is associated with increased mortality, sudden death, and pump failure death (SOR: B, based on retrospective analyses of large-scale randomized controlled trials). However, diuretic resistance or disease severity may explain these latter findings.
Singh
Amrit
A
University of North Carolina, Chapel Hill, NC, USA. amrit_singh@med.unc.edu
Blackwell
Jean
J
Neher
Jon
J
D004232:Diuretics / Q000627:therapeutic use*; D017079:Exercise Tolerance / Q000187:drug effects; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D010359:Patient Readmission; D016896:Treatment Outcome
D004232:Diuretics; D005665:Furosemide