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Loop diuretics are the main therapy for decongestion of patients with advanced acute heart failure. However, these patients often develop diuretic-resistance or even diuretic-refractoriness. In order to overcome such resistance to diuretic, the clinician can increase the dose of furosemide, or change the way of administration (continuous infusion versus boluses) or associate a different class of diuretics (thiazide diuretics, K+-sparing diuretics) up to the addition of low doses of inotropic agents to improve renal perfusion. At the present time there is no evidence in literature in advanced acute heart failure patients about the superiority of the treatment with furosemide in continuous infusion or in intermittent boluses. The aim of the study was to evaluate the efficacy of furosemide in boluses versus continuous infusion in advanced acute heart failure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Continuous infusion of loop diuretics | Active Comparator | Furosemide continuous infusion: 125 or 250 mg die |
|
| Intermittent infusion of loop diuretics | Active Comparator | Furosemide bolus intermittent: 125 or 250 mg die |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Loop Diuretics | Drug | intravenous administration of diuretics |
|
| Measure | Description | Time Frame |
|---|---|---|
| Freedom from congestion | 72 hours after randomization |
| Measure | Description | Time Frame |
|---|---|---|
| Worsening of renal function | Increase in creatinine value > 0.3 mg/dl or increase > 1.5 times | 72 hours after randomization |
| Worsening or persistent HF at 72 h | Need to increase the dose of inotropes or diuretics |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Simone Frea, MD | A.O.U. Città della Salute e della Scienza di Torino | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Simone Frea | Torino | To | 10126 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31256261 | Derived | Frea S, Pidello S, Volpe A, Canavosio FG, Galluzzo A, Bovolo V, Camarda A, Golzio PG, D'Ascenzo F, Bergerone S, Rinaldi M, Gaita F. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure-bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol. 2020 Apr;109(4):417-425. doi: 10.1007/s00392-019-01521-y. Epub 2019 Jun 29. |
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| ID | Term |
|---|---|
| D049994 | Sodium Potassium Chloride Symporter Inhibitors |
| D005665 | Furosemide |
| ID | Term |
|---|---|
| D049990 | Membrane Transport Modulators |
| D045504 | Molecular Mechanisms of Pharmacological Action |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
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| 72 hours after randomization |
| Change in body weight | 72 hours after randomization |
| Laboratory data variations in NTproBNP | 72 hours after randomization |
| Treatment failure | Composed by the following events: persistence of congestion, need to increase diuretic treatment, need of renal replacement treatment | 72 hours after randomization |
| Weight differences based on diuretic dose unity | 72 hours after randomization |
| D004232 | Diuretics |
| D045283 | Natriuretic Agents |
| D045505 | Physiological Effects of Drugs |
| D013424 | Sulfanilamides |
| D013449 | Sulfonamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D013450 | Sulfones |
| D013457 | Sulfur Compounds |