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Abstract
Background Advanced heart failure patients suffer with breathlessness and peripheral oedema, which are frequently treated with parenteral diuretics despite limited evidence.
Aim To analyse the effectiveness of parenteral diuretics on breathlessness and peripheral oedema in advanced heart failure patients.
Methods We searched Embase, MEDLINE(R), PsycINFO, CINAHL and CENTRAL from their respective inceptions to 2021, and performed handsearching, citation searching and grey literature search; limited to English publications. Selection criteria included parenteral (intravenous/subcutaneous) diuretic administration in advanced heart failure patients (New York Heart Association class III–IV). Two authors independently assessed articles for inclusion; one author extracted data. Data were synthesised through narrative synthesis or meta-analysed as appropriate.
Results 4646 records were screened; 6 trials (384 participants) were included. All were randomised controlled trials (RCTs) comparing intravenous continuous furosemide infusion (CFI) versus intravenous bolus furosemide infusion (BFI). Improvement in breathlessness and peripheral oedema (two studies, n=161, OR 2.80, 95% CI 1.45 to 5.40; I2=0%), and increase in urine output (four studies, n=234, mean difference, MD 344.76, 95% CI 132.87 to 556.64; I2=44%), were statistically significant in favour of CFI. Significantly lower serum potassium was found in BFI compared with CFI (three studies, n=194, MD −0.20, 95% CI −0.38 to −0.01; I2=0%). There was no difference between CFI and BFI on reduction in weight, renal function or length of hospital stay.
Conclusions CFI appears to improve congestion in advanced heart failure patients in the short term. Available data came from small trials. Larger, prospective RCTs are recommended to address the evidence gap.
- heart failure
- chronic conditions
- symptoms and symptom management
- dyspnoea
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
Footnotes
Twitter @SBajwah
Contributors AH: principal author involved in all aspects of the systematic review, guarantor. AOO: meta-analysis. NB: involved in the study selection process and editing of the systematic review; SB: project supervisor, involved in the study selection process and editing of the systematic review.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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