Heart failureMedium Term Effects of Different Dosage of Diuretic, Sodium, and Fluid Administration on Neurohormonal and Clinical Outcome in Patients With Recently Compensated Heart Failure
Section snippets
Methods
From June 2005 to September 2007, 410 consecutive patients with compensated HF who were hospitalized previously (within 30 days) for recently decompensated HF with the following characteristics were included in the study: they had to have, according to the definition of refractory HF1 and according to Framingham criteria and NYHA functional classification,12 uncompensated HF (dyspnea, weakness, lower-limb edema, or anasarca) or NYHA class IV HF that was unresponsive to treatment with high doses
Results
Of the 849 patients admitted to the hospital for worsening HF, 36 did not show reduced urinary volume (<500 ml/day) or low natriuresis (<60 mEq/day), 102 had severe co-morbidities, 15 had side effects of ACE inhibitors, 16 had alcohol habits, 93 had creatinine levels >2.0 mg/dl and/or BUN >60 mg (on hospital admission), 97 were classified in NYHA class III on hospital admission, 24 refused consent, 11 required pacemaker implantation, and 26 did not follow the treatment protocol (programmed
Discussion
To our knowledge, this was the first investigation to assess the outcomes of different levels of sodium intake combined with different fluid intakes and loop diuretic doses in medically treated patients with NYHA class IV HF recently discharged in NYHA class II. In the present study, all patients received the same treatment during hospitalization and 30 days after discharge. This criterion allowed us to evaluate the effects of different therapeutic strategies (diuretic doses, sodium diets, and
References (26)
- et al.
Diuretic efficacy of high dose furosemide in severe heart failure; bolus injection vs continuous infusion
J Am Coll Cardiol
(1996) - et al.
Effects of high-dose furosemide and small-volume hypertonic saline solution in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long term effects
Am Heart J
(2003) - et al.
Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure
J Am Coll Cardiol
(2005) - et al.
The usefulness of bioelectrical impedance analysis in differentiating dyspnea due to decompensated heart failure
J Card Fail
(2008) - et al.
The salt-avid state of congestive heart failure revisited
Am J Med Sci
(2008) Pathophysiology of chronic heart failure
Lancet
(1992)Management of refractory congestive heart failure
Am J Cardiol
(1992)- et al.
The epidemiology of heart failure
Eur Heart J
(1997) - et al.
Hypertonic saline solution for renal failure prevention in patients decompensated heart failure
Arq Bras Cardiol
(2007) - et al.
Tolerability and efficacy of high-dose furosemide and small-volume hypertonic saline solution in refractory congestive heart failure
Adv Ther
(1999)
Small-volume hypertonic saline solution and high-dosage furosemide in the treatment of refractory congestive heart failureA pilot study
Clin Drug Invest
High-dose torasemide is equivalent to high-dose furosemide with hypertonic saline in the treatment of refractory congestive heart failure
Clin Drug Invest
Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure
Eur J Heart Fail
Cited by (142)
The current state of evidence for sodium and fluid restriction in heart failure
2024, Progress in Cardiovascular DiseasesRemove the “Strict” From “Restriction”: A #NephJC Editorial on SODIUM-HF
2023, Kidney MedicineSerum Chloride and Heart Failure
2023, Kidney MedicineFluid REStriction in Heart Failure vs Liberal Fluid UPtake: Rationale and Design of the Randomized FRESH-UP Study
2022, Journal of Cardiac FailureAre the recommendation of sodium and fluid restriction in heart failure patients changing over the past years? A systematic review and meta-analysis
2022, Clinical Nutrition ESPENCitation Excerpt :Of these, 1540 were excluded for study design (n = 853), another intervention (n = 458) and another population (n = 229). The full texts of the remaining 25 articles was examined in more detail, and 16 studies were included in qualitative and quantitative synthesis [9,10,20–33]. Fig. 1 shows a flow diagram of the study selection process.