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Advanced heart failure: parenteral diuretics for breathlessness and peripheral oedema – systematic review
  1. Alex Hughes1,
  2. Adejoke O Oluyase1,
  3. Natalie Below2 and
  4. Sabrina Bajwah1
  1. 1Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
  2. 2School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Alex Hughes, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London WC2R 2LS, UK; alexander.hughes3{at}nhs.net

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.

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.