Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) trial.
OBJECTIVE
The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.


RESULTS
161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5 μg kg(-1)min(-1) respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted.


CONCLUSIONS
In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
Filippos K
FK
Triposkiadis
Cardiology Division, Emory University, Atlanta, GA, USA.
Javed
J
Butler
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
Georgios
G
Karayannis
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
Randall C
RC
Starling
Department of Cardiology, "Attikon" University Hospital, Medical School, University of Athens, Athens, Greece.
Gerasimos
G
Filippatos
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
Kathy
K
Wolski
Department of Cardiology, "Attikon" University Hospital, Medical School, University of Athens, Athens, Greece.
John
J
Parissis
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
Charalabos
C
Parisis
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
Dimitrios
D
Rovithis
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
Konstantinos
K
Koutrakis
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece.
John
J
Skoularigis
First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece.
Christos-Konstantinos
CK
Antoniou
First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece.
Christina
C
Chrysohoou
First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece.
Christos
C
Pitsavos
First Cardiology Clinic, Hippokration Hospital, Medical School, University of Athens, Athens, Greece.
Christodoulos
C
Stefanadis
Department of Cardiology, Volos General Hospital, Volos, Greece.
John
J
Nastas
Department of Cardiology, Volos General Hospital, Volos, Greece.
Themistoklis
T
Tsaknakis
First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Lilian
L
Mantziari
First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Georgios
G
Giannakoulas
First Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Haralambos
H
Karvounis
Cardiology Division, Emory University, Atlanta, GA, USA.
Andreas P
AP
Kalogeropoulos
Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece. Electronic address: ggiamou@emory.edu.
Gregory
G
Giamouzis
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D010359:Patient Readmission; D016037:Single-Blind Method; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014556:Urine
D002316:Cardiotonic Agents; D004232:Diuretics; D005665:Furosemide; D004298:Dopamine
Acute heart failure; Dopamine; Furosemide; Worsening renal function