6/28/23, 1:19 AM DRAIN Pathway Feedback Search Clinical Topics Home Studies DRAIN DRAIN Disease Heart failure Trial question What is the role of continuous infusion of furosemide in patients with acute decompensation of advanced chronic HF and high risk for diuretic resistance? Study design Single center Double blinded RCT Population Characteristics of study participants 10.0% female N = 80 90.0% male 80 patients (8 female, 72 male) Inclusion criteria: patients admitted for acute decompensation of advanced chronic HF with criteria of high risk for diuretic resistance Key exclusion criteria: reversible causes of acute HF, cardiogenic shock, chronic renal failure stage V Interventions N=40 continuous infusion (intravenous infusion of furosemide 120 mg/day or 240 mg/day continuously for up to 72 hours) N=40 bolus intermittent (intravenous furosemide bolus of 120 mg/day or 240 mg/day every 12 hours for up to 72 hours) https://web.pathway.md/studies/recRZRgWN1QPyqUX8 1/2 6/28/23, 1:19 AM DRAIN Pathway Primary outcome Freedom from congestion at 72 hours 48.0 % 48 36.0 % 25 24.0 % Significant increase 12.0 % NNT = 4 0.0 % Continuous infusion Bolus intermittent Significant increase in freedom from congestion at 72 hours (48% vs. 25%; OR 2.71, 95% CI 1.05 to 7) Secondary outcomes Significant increase in total urinary output after 72 hours (10020 ,020 ml vs. 8612 ,020 ml; OR 1.2, 95% CI 1.03 to 1.4) Significant decrease in treatment failure (15% vs. 38%; OR 0.29, 95% CI 0.1 to 0.87) No significant difference in worsening HF after 72 hours (20% vs. 30%; OR 0.59, 95% CI 0.18 to 1.83) Safety outcomes No significant differences in worsening of renal function, heart transplantation, LV assist device implantation, or in-hospital death. Significant difference in diuretic response (-1.0 vs. -0.6) and estimated right atrial pressure at echo-Doppler after 72 hours (13.5 mmHg vs. 16.4 mmHg). Conclusion In patients admitted for acute decompensation of advanced chronic HF with criteria of high risk for diuretic resistance, continuous infusion was superior to bolus intermittent with respect to freedom from congestion at 72 hours. Reference Simone Frea, Stefano Pidello, Alessandra Volpe et al. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure-bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol. 2020 Apr;109(4):417-425. Open reference URL https://web.pathway.md/studies/recRZRgWN1QPyqUX8 2/2