title: Continuous infusion of furosemide combined with low-dose dopamine compared to intermittent boluses in acutely decompensated heart failure is less nephrotoxic and carries a lower readmission at thirty days.
abstract: BACKGROUND
  Furosemide is a potent loop diuretic that is widely used in the management of heart failure. Several reports have suggested that continuous intravenous administration of loop diuretics may be superior to intermittent administration. In addition the effect of low-dose dopamine to improve renal perfusion might be of benefit to this patient cohort.
  
  
  METHODS
  We retrospectively evaluated 116 consecutive cardiac care unit patients, who were admitted with acute decompensated heart failure and were divided into two equal groups according to diuretic protocol. Group A patients received furosemide by continuous infusion combined with low-dose dopamine infusion. Group B patients received bolus therapy of intravenous furosemide. The effect on renal function and readmission rate was recorded.
  
  
  RESULTS
  Among 116 patients (60% males, average age 71, range 46-96 years) 41% had ischemic cardiomyopathy, NYHA functional Class was 3.5 ± 0.5 and average EF was 21% ± 7%. On admission, patients in Group A had creatinine (Cr) 2.3 ± 0.2 mg/dL, blood urea nitrogen (BUN) 49.2 ± 25 mg/100 ml and median b-type natriuretic peptid (BNP) 1340 pg/mL, compared to group B patients with Cr 1.7 ± 1.2 mg/dL, BUN 32 ± 22 mg/100 ml and median BNP 1106 pg/mL. The average furosemide dose in group A was 7.9 ± 3.5 mg/hr compared to 7.6 ± 2.7 mg/hr for group B (p=NS). At the end of the study, patients in group A had lower Cr 1.8 ± 0.9 (p=0.0001), lower BUN 43.6 ± 22.9 (p=NS), an increase in estimated glomerular filtration rate 57.4 ± 27.4, a shorter hospital stay (p=0.015) and lower readmission rates at 30 days (p=0.0003).
  
  
  CONCLUSIONS
  Continuous infusion of furosemide in addition to low-dose dopamine is safe, effective and less nephrotoxic than intermittent boluses in patients admitted with acute decompensated heart failure and portends a shorter hospital stay and lower readmission rates at 30 days.
authors.affiliation: The ACAP Program, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY, USA. EAziz@chpnet.org
authors.forename: Emad F
authors.initials: EF
authors.lastname: Aziz
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Alviar
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Cordova
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Bastawrose
authors.forename: Chaithanya K
authors.initials: CK
authors.lastname: Pamidimukala
authors.forename: Andre
authors.initials: A
authors.lastname: Tojino
authors.forename: Terrence S
authors.initials: TS
authors.lastname: Park
authors.forename: Dan
authors.initials: D
authors.lastname: Musat
authors.forename: Marrick
authors.initials: M
authors.lastname: Kukin
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001806:Blood Urea Nitrogen; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D005665:Furosemide; D003404:Creatinine; D004298:Dopamine