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DOSE: Diuretic dosage, IV delivery approach did not affect symptoms of patients with acute decompensated HF
Felker G. N Engl J Med. 2011;364:797-805.
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Administration of diuretics intravenously via bolus vs. continuous infusion or at low dose vs. high dose did not significantly alter the patients’ global assessment of symptoms or renal function among those with acute decompensated HF.
“Although loop diuretics are an essential component of therapy for acute decompensated HF, there have been few prospective data to guide decision-making regarding the use of these agents,” the researchers wrote. “In this trial, we found no significant differences in either patients’ global assessment of symptoms or the change in the creatinine level from baseline to 72 hours when diuretic therapy was administered by means of boluses as compared with continuous infusion or with a low-dose strategy as compared with a high-dose strategy.”
The Diuretic Optimization Strategies Evaluation (DOSE) trial was a prospective, double blind study in which researchers randomly assigned 308 patients with acute decompensated HF to furosemide administered intravenously via bolus every 12 hours (n=156) or continuous infusion (n=152) and at a low dose (defined as equivalent to a patient’s previous oral dose; n=151) or high dose (2.5 times the previous oral dose; n=157). The study treatment, with group assignments concealed, was continued for up to 72 hours, whereas afterward, all treatment was open-label and at the treating physician’s discretion.
Overall, 130 patients (42%) either died, were rehospitalized or visited the ED within the 60-day follow-up period. Investigators reported no significant difference regarding bolus vs. continuous infusion in patients’ global assessment of symptoms (P=.47), as well as in the mean change in creatinine level (P=.45).
Additionally, a nonsignificant trend was noticed regarding a greater improvement in patients’ global assessment of symptoms in those given high dose vs. low dose (P=.06), but not in mean change in creatinine level (P=.21).
To view Cardiology Today’s initial coverage of the DOSE trial from ACC 2010, click here.
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