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A randomized controlled trial of loop diuretics was published in NEJM two weeks ago . The trial involved 308 patients, from 26 clinical sites. The details are below: Inclusion: Enrollment within 24 hrs of admission with ADHFClinical diagnosis of heart failureHistory of chronic heart failure and receipt of an oral loop diuretic for at least 1 month before hospitalization, at a dose between 80 mg and 240 mg daily in the case of furosemide (or equivalent loop diuretic) Exclusion: SBP <90mmHg Serum creatinine > 3mg/dLIV vasodilators or IV inotropic agents Intervention: 2 x 2 factorial design; 1:1:1:1 randomization, stratified on centreHigh dose (2.5 x home diuretic dose) vs low dose (home oral dose)ANDContinuous vs bolus dosing (every 12 hours) of loop diureticsAt 48 hours, the treating doctors could increase the dose by 50% (remaining blinded), make no changes (remaining blinded) or change to open-label oral diuretics Primary Outcome: Efficacy – global assessment of symptoms from baseline to 72 hoursSafety – change in serum creatinine from baseline to 72 hoursAs these were co-primary endpoints, p<0.025 for each was required> Results: There were no significant differences in the either the primary efficacy or safety endpointsbetween continuous vs bolus dose, nor between high vs low dose diuretics. The patients in the high-dose group had greater relief of dyspnoea and had higher net fluid loss; however, this was offset by a greater increase in serum creatinine after 72 hours. |
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