Loop Diuretic Therapy in Acutely Decompensated Heart Failure
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Continuous Furosemide Infusion, Intermittent Furosemide Infusion.
- Who it may be relevant to
- Registry conditions: Acute Heart Failure. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Italy
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Continuous Versus Bolus Intermittent Loop Diuretic Infusion in Acutely Decompensated Heart Failure: Evaluation of Renal Function, Congestion Signs, BNP and Outcome
Overview
DiurHF is a prospective, multicenter, observational, study that compares continuous with intermittent infusion of furosemide in patients admitted with a diagnosis of ADHF. Previous pilot study design was planned to anticipate a larger multicenter trial able to definitively evaluate the optimal loop diuretic use strategy in patients with ADHF.
Detailed description
The use of intravenous loop diuretics is a cornerstone of therapy for acutely decompensated heart failure (ADHF); significant concerns have been raised regarding risks and benefits of loop diuretics, particularly about dosage and administration regimen.
Recent guidelines recommend the use of these drugs to reduce left ventricular filling pressure, avoid pulmonary edema, and alleviate peripheral fluid retention.
Some studies have provided guidelines for the administration of these drugs in clinical practice, but data interpretation remains challenging due to the frequent exclusion of patients with kidney disease from major ADHF clinical trials. Therefore, it is not clear if continuous infusion is better than intermittent boluses in terms of decongestion, maintenance of renal filtration function and prognosis.
On the other hand, continuous administration should provide a more constant delivery of the drug into the tubule, potentially reducing these phenomena.
The aim of the study is to evaluate the better loop diuretic intravenous administration in terms of renal function, congestion signs, BNP and outcome.
Interventions
- Drug Continuous Furosemide Infusion
Intravenous continuous Furosemide infusion - Drug Intermittent Furosemide Infusion
Intravenous bolus intermittent Furosemide Infusion
Primary outcome measures
- Cardiac death and rehospitalization for HF [Time frame: 180 days]
Secondary outcome measures (12)
- length of hospital stay (days) [Time frame: From date of randomization until the discharge (7-12 days)]
- Inotropes agents [Time frame: From date of randomization until the discharge (7-12 days)]
- hypertonic saline solution [Time frame: From date of randomization until the discharge (7-12 days)]
- Acute kidney injury [Time frame: From date of randomization until the discharge (7-12 days)]
- Body weight changes [Time frame: from admission to discharge (7-12 days)]
- Diuresis [Time frame: from admission to discharge (7-12 days)]
- BNP changes [Time frame: From date of randomization until the discharge (7-12 days)]
- BUN changes [Time frame: From date of randomization until the discharge (7-12 days)]
- Reduction of edema [Time frame: From date of randomization until the discharge (7-12 days)]
- Reduction of dyspnea [Time frame: From date of randomization until the discharge (7-12 days)]
- Regression of pulmonary congestion [Time frame: From date of randomization]
- Diuretic efficiency: (Weight loss/days of infusion)/ (Mean daily furosemide dosage/40 mg of furosemide) [Time frame: From hospital admission until the discharge (7-12 days)]
Eligibility criteria
Inclusion criteria
- Patients over 18 years;
- Patients with diagnosis of ADHF(dyspnea, orthopnea, peripheral edema or major fatigue and at least two clinical signs including rales, hepatomegaly, pulmonary congestion on chest radiography, jugular vein dilatation, or a third heart sound);
- Blood BNP > 100 pg/mL;
ADHF: Acute Decompensated Heart Failure; BNP: B-type Natriuretic Peptide; IV: IntraVenous; LVEF: Left Ventricular Ejection Fraction.
Exclusion criteria
- Patients who receive more than 40 mg of IV furosemide;
- End-Stage renal disease or renal replacement therapy;
- Recent myocardial infarction (within thirty days of screening);
- Systolic blood pressure < 80 mmHg;
- Creatinine levels > 4 mg/dL;
- Patients affected by sepsis, liver diseases, inflammatory diseases or neoplastic diseases.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Case-control
Study locations
Italy · 4 centers
- Ospedale Madonna della Navicella — Chioggia
- Azienda Ospedaliera di Padova — Padova
- University of Rome La Sapienza — Roma
- Department of Internal Medicine, Cardiovascular Diseases Unit — Siena
Publications
- Palazzuoli A, Pellegrini M, Ruocco G, Martini G, Franci B, Campagna MS, Gilleman M, Nuti R, McCullough PA, Ronco C. Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial. Crit Care. 2014 Jun 28;18(3):R134. doi: 10.1186/cc13952. PMID 24974232
- Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar PMID 21366472
- Lala A, McNulty SE, Mentz RJ, Dunlay SM, Vader JM, AbouEzzeddine OF, DeVore AD, Khazanie P, Redfield MM, Goldsmith SR, Bart BA, Anstrom KJ, Felker GM, Hernandez AF, Stevenson LW. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue PMID 26041600
- ter Maaten JM, Dunning AM, Valente MA, Damman K, Ezekowitz JA, Califf RM, Starling RC, van der Meer P, O'Connor CM, Schulte PJ, Testani JM, Hernandez AF, Tang WH, Voors AA. Diuretic response in acute heart failure-an analysis from ASCEND-HF. Am Heart J. 2015 Aug;170(2):313-21. doi: 10.1016/j.ahj.2015.05.003. Epub 2015 May 9. PMID 26299229
- Voors AA, Davison BA, Teerlink JR, Felker GM, Cotter G, Filippatos G, Greenberg BH, Pang PS, Levin B, Hua TA, Severin T, Ponikowski P, Metra M; RELAX-AHF Investigators. Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome--an analysis from RELAX-AHF. Eur J Heart Fail. 2014 Nov;16(11):1230-40. doi: 10.1002/ejhf.170. Epub 2014 Oct 7. PMID 25287144
- Palazzuoli A, Dini FL, Pugliese NR, Ruocco G, Severino P, Vizza D, Carbonara R, Passantino A, Carluccio E. Right Ventricular-Pulmonary Artery Uncoupling and Strain in Acute Heart Failure. J Am Heart Assoc. 2025 May 6;14(9):e039858. doi: 10.1161/JAHA.124.039858. Epub 2025 May 2. PMID 40314350
- Palazzuoli A, Ruocco G, Vescovo G, Valle R, Di Somma S, Nuti R. Rationale and study design of intravenous loop diuretic administration in acute heart failure: DIUR-AHF. ESC Heart Fail. 2017 Nov;4(4):479-486. doi: 10.1002/ehf2.12226. Epub 2017 Oct 4. PMID 28980452
Identifiers
NCT: NCT02638142 · DIUR-AHF