Effectiveness of continuous infusions of loop diuretics for severe heart failure.

Heart failure is a growing worldwide epidemic resulting in frequent hospitalizations and increased resource utilization. A major cause of hospitalization is congestive symptoms and impaired functional capacity due to sodium and water retention. Diuretic resistance, which is common among patients with severe heart failure, may inhibit diuresis, thus prolonging hospitalizations. The current evidence suggests that continuous infusions are a potentially effective method for delivering high daily doses of diuretics and rapidly removing large amounts of excess sodium and water. In our experience, continuous intravenous infusions of furosemide are well tolerated and may shorten hospitalizations, which in turn reduces overall costs. Although the current evidence is largely limited to observational reports and small uncontrolled studies, the consistent findings of efficacy and safety warrant the further investigation of this treatment strategy in randomized controlled trials.