Abstract 1891: Continuous Furosemide Infusion is Safe and Effective in Outpatient Treatment of Refractory Heart Failure
Optimal treatment strategies for patients (pts) with refractory heart failure (RHF) despite high dose oral therapies are not well characterized due to paucity of controlled clinical trials. Nesiritide use is limited by its high cost, restriction to the subgroup of pts with LVEF<30% and its possible adverse effects on renal function and mortality. Intravenous (IV) loop diuretics are guideline-recommended treatment for in-pt management of RHF although the effects of this therapy on renal function and mortality are unknown. We sought to assess efficacy and safety of high dose continuous IV furosemide in RHF in an out-pt setting.
Methods: 48 consecutive pts referred to the Yale HF Center with symptomatic RHF received an average 150 mg of IV bolus furosemide followed by continuous IV infusion (60 mg/hr) for 3– 4 hours. Infusions were repeated up to 5 times weekly as necessary. No other inotropic or vasodilator agents were used. Treatment efficacy was assessed by NYHA class; change in body weight and BNP levels; need for hospitalization. Safety outcome measures included renal function and mortality.
Results: Mean age was 63.5 years (68% men); mean follow-up was 134 days. 54% (n=26) had a LVEF<40% (mean of 25%). Moderate-severe chronic kidney disease (Creatinine-Clearance<60 ml/min) was present in 54% (mean 38±72.4 ml/min). A mean of 8 furosemide infusions were given. In response to serial infusions, all pts improved symptomatically with mean total weight loss 8.3 lbs (maximal 28 lbs). Mean BNP decreased significantly from 1271 to 728 ng/ml (p<0.0001). 4 pts required hospitalization for diuretic resistance to out-pt infusion. No severe adverse effects of treatment were reported. Renal function remained stable in 83% (n=40) of pts, while 10% (n=5) deteriorated (rise of creatinine >0.3mg/dl), and 6% (n=3) improved (fall of creatinine >0.3mg/dl). Mild, uncomplicated hypokalemia occurred in 16%. No pts died during the course of infusion therapy.
Conclusions: IV furosemide infusion in an out-pt setting was safe and effective in the treatment of RHF. Furosemide is inexpensive and offers therapy to all RHF pts regardless of renal or ventricular function. Further studies of out-pt furosemide infusion as part of a multi-disciplinary RHF disease management program is warranted.