Continuous Furosemide Infusion Superior to Bolus Furosemide in Heart Failure

Administration of continuous furosemide infusion demonstrates superiority over bolus furosemide in terms of its diuretic and weight loss effects, according to a meta-analysis published in Anaesthesia.

Researchers reviewed various clinical trials that included patients with acute decompensated heart failure (HF) who received either continuous or bolus furosemide administration. Specifically, the investigators evaluated mortality, weight loss, length of hospital stay, and diuretic outcomes in treated patients. A total of 8 trials with 669 participants were included in the final analysis.

In 4 studies that reported mortality outcomes, the investigators found no statistically significant difference between patients receiving continuous infusion vs bolus administration of furosemide (n=491; I² =0%; odds ratio [OR], 1.65; 95% CI, 0.93-2.91; P =.08).

The pooled data from 6 studies also demonstrated no significant difference between groups in terms of hospital length of stay (n=576; I² =71%; mean difference, 0.27; 95% CI, –1.35 to 1.89 days; P =.74).

Investigators did find an association between continuous furosemide infusion and greater reductions in body weight compared with bolus administration in 5 studies (n=516; I² =0%; mean difference, 0.70; 95% CI, 0.12-1.28 kg; P =.02). In addition, continuous infusion resulted in greater reductions in brain natriuretic peptide than in the bolus group (n=390; I² =0%; mean difference, 399.5; 95% CI, 152.7-646.3 ng.1^-1; P <.01). Finally, the investigators found that continuous furosemide infusion also had a greater diuretic effect at 24 hours (n=390; I² =33%; mean difference, 461.5; 95% CI, 133.7-789.4 mL; P <.01).

Similar to most meta-analyses, the investigators believe this study is limited by the varying patient characteristics, small sample sizes, and differing medication dosages present across the randomized clinical trials included.

Despite this limitation, this study may provide “an estimate of important outcomes…[and] should be useful to inform future practice in the management of HF.”

Reference

Ng KT, Yap JLL. Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials [published online September 22, 2017]. Anaesthesia. doi:10.1111/anae.14038