Does Initial Diuretic Dose Matter in Heart Failure Exacerbation?

For many clinicians, the landmark DOSE randomized trial led to higher loop diuretic dosing for inpatients with heart failure (HF) exacerbations. DOSE showed more diuresis and greater weight loss early in hospitalization with higher-dose loop diuretics (Figure 1).

In this current study, investigators used data from 24 U.S. hospitals and >14,000 patients to retrospectively assess the effects of initial diuretic dose selection on outcomes in patients hospitalized for HF exacerbations. Patients who were not taking loop diuretics at home or those who were taking thiazide diuretics were excluded. The researchers compared three groups of patients who received the following initial inpatient intravenous diuretic doses (after emergency departm…