Continuous or bolus furosemide viable in acute heart failure

The choice between continuous and bolus furosemide in the treatment of acute heart failure (AHF) should be by physician’s preference as both regimens offer satisfactory outcomes, a recent systemic review and meta-analysis suggests.

Among 10 randomized controlled trials included for analysis, 371 patients were treated with intermittent bolus furosemide, while 364 received the diuretic via continuous infusion. The daily total furosemide dosage did not differ significantly between the two groups (weighted mean difference [WMD], 8.9 mg; 95 percent confidence interval [CI], -13.42 mg to 31.22 mg; p=0.43). [J Card Fail 2019, doi: 10.1016/j.cardfail.2019.11.013] 

Patients who received continuous furosemide had significantly higher mean daily urine output (WMD, 444.37 mL; 95 percent CI, 196.23 mL to 692.51 mL; p<0.001) and weight loss (WMD, 0.89 kg; 95 percent CI, 0.04 kg to 1.75 kg; p=0.04) compared with those who received bolus furosemide.

No significant differences were found in the length of hospital stay and in serum sodium, potassium and creatinine levels between the groups. Mortality and post-treatment brain natriuretic peptide (BNP) levels were not evaluated.

Based on the modest differences shown between the groups, the choice of furosemide regimen in AHF remains physician’s preference, according to the investigators from the Chinese University of Hong Kong.