Acute Heart Failure
Conditions
Keywords
Heart Failure, Dopamine, Furosemide, Worsening Renal Function, Hypokalemia, Outcomes, Prognosis
Brief summary
The aim of this study is to compare the effects of high-dose furosemide versus low-dose furosemide combined with low-dose dopamine on diuresis, renal function, electrolyte balance, and 60-day post-discharge outcomes in patients hospitalized with acute decompensated heart failure.
Detailed description
Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated heart failure (ADHF) are common and portend poor prognosis. Low dose dopamine infusion improves renal perfusion. Whether dopamine infusion improves diuresis and/or reduces renal complication in ADHF is not known. The aim of this study is to compare the effects of high-dose furosemide (HDF, 40 mg furosemide bolus IV, followed by continuous IV infusion of 20 mg/h for a total of 8 hours) vs. low-dose furosemide combined with low-dose dopamine (LDFD, 40 mg furosemide bolus IV, followed by continuous IV infusion of 5 mg/h furosemide plus 5μg/kg/min dopamine for a total of 8 hours) on diuresis, renal function, electrolyte balance, and 60-day post-discharge outcomes in patients hospitalized with ADHF.
Interventions
DRUGlow-dose dopamine + low-dose furosemide
low-dose furosemide combined with low-dose dopamine (LDFD, furosemide 5 mg/h plus dopamine 5μg/kg/min intravenously)
DRUGFurosemide
High-dose furosemide(HDF, furosemide 20 mg/h intravenously)
Sponsors
Larissa University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* patients with New York Heart Association (NYHA) functional class IV heart failure according to the American Heart Association (AHA) classification, namely dyspnea on minimal exertion or rest dyspnea, orthopnea, and paroxysmal nocturnal dyspnea * signs of congestion (third heart sound or pulmonary rales on physical examination) * pulmonary congestion on chest x-ray * serum B-type natriuretic peptide levels \> 400 pg/ml or NT-proBNP \> 1500 pg/ml * echocardiographic documentation of systolic or diastolic dysfunction * all candidate patients must be: * Age \>18 years old * on medical therapy with an ACE-inhibitor and/or a β-blocker * experiencing an acute decompensation of known chronic HF * Having baseline oxygen saturation \<90% on admission arterial blood gas
Exclusion criteria
* the investigators will exclude patients with: * acute de novo HF * severe renal failure (serum creatinine \> 200 μmol/L or GFR \< 30 ml/min/1.73m2) * admission systolic blood pressure \< 90 mm Hg * severe valvular disease * known adverse reactions to furosemide or dopamine * HF secondary to congenital heart disease * a scheduled procedure with a need for IV contrast dye * a scheduled cardiac surgery within 6 months
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1-year mortality or rehospitalization (all-cause, cardiovascular, non-cardiovascular, and due to worsening heart failure). | 1-year |
Secondary
| Measure | Time frame |
|---|---|
| 60-day mortality or rehospitalization (all-cause, cardiovascular, non-cardiovascular, and due to worsening heart failure). | 60 days post discharge |
Countries
Greece
Contacts
Primary ContactFilippos Triposkiadis, MD
Backup ContactGregory Giamouzis, MD
Outcome results
None listed