title: A prospective, randomized study to evaluate the efficacy of various diuretic strategies in acute decompensated heart failure.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of various initial strategies of loop diuretic administration in patients with acute decompensated heart failure (ADHF) on diuresis, renal function, electrolyte balance and clinical outcomes.
  
  
  METHODS
  Consecutive patients admitted with ADHF were randomized into three groups - intravenous furosemide infusion + intravenous dopamine, intravenous furosemide bolus in two divided doses and intravenous furosemide continuous infusion alone. At 48 h, the treating physician could adjust the diuretic strategy. Primary endpoint was negative fluid balance at 24 h after admission. Secondary end points were duration of hospital stay, negative fluid balance at 48, 72, 96 h, the trend of serum electrolytes, and renal function and 30 day clinical outcome (death and emergency department visits).
  
  
  RESULTS
  Overall ninety patients (thirty in each group) were included in the study. There was a greater diuresis in first 24 h (p = 0.002) and a shorter hospital stay (p = 0.023) with the bolus group. There was no significant difference in renal function and serum sodium and serum potassium levels. There was no difference in the number of emergency department visits among the three groups.
  
  
  CONCLUSIONS
  All three modes of diuretic therapies can be practiced with no difference in worsening of renal function and electrolyte levels. Bolus dose administration with its rapid volume loss and shorter hospital stay might be a more effective diuretic strategy.
authors: Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India. Electronic address: drruchitshah@gmail.com.
authors: Ruchit A
authors: RA
authors: Shah
authors: Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Vijayakumar
authors: V
authors: Subban
authors: Physician Assistant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Anitha
authors: A
authors: Lakshmanan
authors: Resident in Cardiology, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Srinivasan
authors: S
authors: Narayanan
authors: Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Kalaichelvan
authors: K
authors: Udhayakumaran
authors: Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Balaji
authors: B
authors: Pakshirajan
authors: Senior Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Jaishankar
authors: J
authors: Krishnamoorthy
authors: Senior Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Kalidass
authors: K
authors: Latchumanadhas
authors: Senior Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Ezhilan
authors: E
authors: Janakiraman
authors: Director, Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
authors: Ajit S
authors: AS
authors: Mullasari
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004232:Diuretics / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D004232:Diuretics
keywords: Acute decompensated heart failure; Diuretic; Dopamine; Electrolyte balance; Renal function