COMPARISON OF THE OUTCOME OF CONTINUOUS INFUSION VERSUS INTERMITTENT BOLUS DOSING OF FUROSEMIDE IN ACUTE HEART FAILURE PATIENTS

Abstract

Background and Objectives: Acute heart failure often need intravenous furosemide; however the ideal method of administration is still contested. Continuous infusion may confer renal protection by maintaining steady medication levels, whereas intermittent bolus may yield enhanced diuresis. Our study objectives are 1) to compare the mean serum creatinine levels and BUN levels 2) to compare mean urine output, eGFR and BNP following continuous infusion versus intermittent bolus dosing of furosemide in acute heart failure patients. Methodology: This prospective, randomized trial enrolled 60 ADHF patients (NYHA Class III-IV, LVEF <50%) at a tertiary cardiac center of Rawalpindi from January to June 2025. Patients of continuous infusion group received furosemide infusion at a dose of 2-3mg/h and intermittent group patients received furosemide at a dose of 40mg every 8hours. All patients received protocolized fluid/electrolyte monitoring. Primary endpoints included 72-hour change in renal function (creatinine and BUN) while, secondary endpoints comprised BNP reduction, urine output and eGFR. Data was evaluated using IBM-SPSS Version 25. Mean values of primary and secondary outcomes were compared using t-test and p ≤ 0.05 considered significant. Results. Continuous infusion demonstrated superior renal protection, with significantly lower creatinine (1.33 ± 0.66 vs. 1.78 ± 0.50 mg/dL; p=0.004) and BUN levels (18.32 ± 7.63 vs. 36.40 ± 20.47 mg/dL; p<0.001). Intermittent bolus yielded higher urine output (2718.90 ± 829.83 vs. 2078.18 ± 429.73 mL, p<0.001). Although not statistically significant (p=0.110), a trend indicating a higher eGFR (61.63 ± 11.14 vs 53.70 ± 24.31 mL/min/1.73m²) further corroborated the renal advantages of continuous infusion. Conclusions: Continuous furosemide infusion offers superior renal protection, while intermittent bolus provides more robust diuresis. Treatment selection should consider patient-specific factors, such as age, comorbidities, and symptom duration. These findings support personalized decongestion strategies in AHF.