Outcomes of initial intravenous diuretic dose in Acute heart failure

Introduction

Acute heart failure is a frequent motive for emergency admissions. Intravenous loop diuretics remain the cornerstone of its management, yet its optimal initial dose remains controversial

Objective

Comparison of initial furosemide dose between ER practicians and both guidelines & cardiology specialists, analysis of clinical improvement in the 3 categories, analysis of lack of clinical improvement in the 3 categories in relation with creatinine serum levels

Method

The present study included 300 patients from the Emergency Room. Anthropometric & clinical elements were noted, as well as heart risk factors & anterior therapeutics. Patients were divided into two groups depending on their oral diuretic intake. They were further classified into three IV bolus categories: Optimal, More & Less, following guidelines. Clinical elements including diuresis and congestion physical signs were noted after 24 h.

Results

In our study, 36.3% of our patients are on diuretic regimen, whereas 63.7% never received diuretics. Globally, emergency practicians indicated initial doses similar to the cardiologist assessment 36.7% of the, whereas it was different 63.7% of the time, mostly higher doses (36%). After dividing patients by their anterior diuretic intake, we found that emergency practicians tend to give higher doses to diuretic free patients (47.4%), whereas they mostly don’t increase diuretic doses for patients who are already on diuretics (18.2%), with sometimes even lower boluses (36.4%). Patients in the Optimal category had 81.8% adequate mean diuresis after 24 h, as well as 85% clinical congestion improvement. Patients in the Less category had 60% adequate diuresis, and only 40% clinical improvement, with some worsening cases (8%). Patients in the More category had 81.8% adequate diuresis, as well as 85% clinical improvement. Patients in the More category had 76,9% adequate mean diuresis after 24 h, less than in the Optimal category, and only 80% clinical congestion improvement (Fig. 1). Through analysis by Logistic Regression, we found that the unimprovement of congestion in the Low category isn’t related to creatinine serum levels. We also found that patients who didn’t improve with Optimal category doses didn’t have higher creatinine serum levels.

Conclusion

Our study shows that guidelines-based initial diuretic doses are effective on congestion improvement after 24 h, and consequently should be followed by all medical practicians.