DRAIN
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
90.0% male
N = 80
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).
Primary outcome
Freedom from congestion at 72 hours
48%
25%
48.0 %
36.0 %
24.0 %
12.0 %
0.0 %
Continuous
infusion
Bolus
intermittent
Significant
increase ▲
NNT = 4
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.
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