DOSE-AHF Diuretic Optimization Strategies Evaluation in Acute Heart Failure Duke Heart Failure Research Pager:

Purpose Double blinded controlled study to evaluate safety and efficacy of high intensification diuretics vs. low intensification diuretics in Acute Decompensated Heart Failure (ADHF) and IV continuous vs. intermittent bolus q12 hours – –Double blinded study meaning subjects, MD, and research team are unaware of what treatment is being received.

Inclusion Criteria ADHF with 24 hrs of admission Potential need for IV loop diuretics for next 48hrs

Interventions Randomized to 1 of 4 combination treatments Low dose IV Furosemide by continuous infusion Low dose IV Furosemide by intermittent bolus q12 hrs High dose IV Furosemide by continuous infusion High dose IV Furosemide by intermittent bolus q12 hrs Subjects receive BOTH IV bolus q12 hrs AND continuous infusion; only one contains the active study drug Furosemide

Interventions Open label Furosemide may be used at the discretion of the physician. –If the MD feels the patient is not being diuresed effectively, additional Furosemide may be given in addition to study drug.

Nursing Roles Start at the same time: –Continuous infusion (volume of 250 ml) with a flow rate of 10 ml/hr –Bolus (volume of 50 ml) with a flow rate of 40.2 ml/hr After 12 hours: –Hang the next bolus (volume of 50 ml) with a flow rate of 40.2 ml/hr Ask patients to complete the Visual Analog Scales (VAS*): Global Well-being and Dyspnea at specific intervals: 6 hrs and 12 hrs after initiation of study drug infusion and daily for 4 days Only 1 IV line necessary; both drugs can run through same IV *Found in patient’s chart box.

Outcomes Why is this study being done? –SAFETY: Determine the change in serum creatinine from time of randomization to 72 hrs –EFFICACY: As indicated by the Global Well- being and Dyspnea Visual Analog Scales (VAS)