![]() Multiple times a day, we get a patient in the ER with a heart failure exacerbation. Hello and welcome to Episode 39 of ER-Rx. – Overall, there was no difference in median length of stay no matter what dose or administration strategy was chosen, nor was there a difference in composite end points that included mortality and rehospitalization The “high-dose” group also had greater net fluid loss, weight loss, and relief from dyspnea, but that came with a significantly higher risk of worsening renal function- but note that this was a transient effect that did not lead to any bad outcomes by day 60 – In terms of dosing, there was a non-significantly higher improvement in the primary efficacy endpoint in the “high-dose” group. There was also no difference in the primary safety end point of mean change in creatinine levels or any other secondary efficacy or safety outcomes – In terms of administration of bolus vs continuous infusion, there were no differences between the two in the primary efficacy end point of patient-reported global assessment of symptoms scores. – For example, if a patient was on 20 mg BID furosemide at home (40 mg daily), they were randomized to receiving either 40 mg IV daily (“low-dose” group) or 100 mg IV daily (“high-dose group). The “DOSE” trial enrolled patients into either a “low-dose” strategy (equal to home diuretic dose in furosemide equivalents) or a “high-dose” strategy (home diuretic dose in furosemide equivalents x 2.5) and to either receiving the total dose as a bolus every 12 hours or as a continuous infusion – The optimal dose and administration strategy of diuretics during heart failure exacerbations remains largely unknown
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