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DOSE-AHF
Diuretic Optimization Strategies Evaluation in
Acute Heart Failure
Duke Heart Failure Research
Pager: 970-0736
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 Wellbeing and Dyspnea Visual Analog Scales
(VAS)