title: Intravenous Diuretic Therapy for the Management of Heart Failure and Volume Overload in a Multidisciplinary Outpatient Unit.
abstract: OBJECTIVE
  This study sought to evaluate the effectiveness of intravenous (IV) diuretic treatment for volume management in heart failure (HF).
  
  
  BACKGROUND
  Limited data exist regarding IV diuretics for the outpatient treatment of volume overload in HF patients.
  
  
  METHODS
  We analyzed 60 consecutive patients with chronic HF and clinical evidence of worsening congestion who received a bolus and 3-h IV infusion of furosemide at an outpatient HF clinic. Diuretic dosing was derived from the maintenance oral loop diuretic dose with a standardized conversion algorithm. Outcomes included urine output during the visit, weight loss at 24 h, and hospitalization and mortality at 30 days. Safety outcomes included hypokalemia and worsening of renal function. Outcomes were analyzed across subgroups defined by maintenance diuretic dose and ejection fraction (EF).
  
  
  RESULTS
  The median age of the cohort was 70 years (interquartile range [IQR]: 58 to 80 years), and the median daily loop diuretic dose was 240 mg (IQR: 80 to 800 mg) oral furosemide or equivalent. Twenty-six patients (43.3%) were women, and 36 (60%) had an EF ≤45%. For the entire cohort, the median urine output and 24-h weight loss were 1.1 l (IQR: 0.6 to 1.4 l) and 1.1 kg (IQR: 0.2 to 1.9 kg), respectively. Outcomes were similar across patients with varying maintenance diuretic doses (<40 mg, 40 to 160 mg, 160 to 300 mg, or >300 mg of furosemide or equivalent) and in patients with reduced or preserved EF. Transient worsening of renal function and hypokalemia occurred in 10 patients (8.9%) and 4 patients (3.5%). Although hospitalization was reported as imminent for 28 patients (52.8%), the observed rate of all-cause hospitalization was 31.7% at 30 days with no deaths.
  
  
  CONCLUSIONS
  Short courses of IV diuretics for volume management in patients with HF were safe and associated with significant urine output and weight loss across a wide range of maintenance diuretic doses and EF. This strategy may provide an alternative to hospitalization for the management of selected HF patients.
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: LBuckley2@vcu.edu.
authors.forename: Leo F
authors.initials: LF
authors.lastname: Buckley
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Carter
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lina
authors.initials: L
authors.lastname: Matta
authors.affiliation: Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences University, Boston, Massachusetts.
authors.forename: Judy W
authors.initials: JW
authors.lastname: Cheng
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Craig
authors.initials: C
authors.lastname: Stevens
authors.affiliation: Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Roman M
authors.initials: RM
authors.lastname: Belenkiy
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Burpee
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Young
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Weiffenbach
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smallwood
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D002306:Cardiac Volume / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006940:Hyperemia / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide
keywords: ambulatory treatment; heart failure; loop diuretics