BACKGROUND Decongestion is a primary goal during hospitalizations for decompensated heart failure (HF). However, data surrounding the preferred route and strategy of diuretic administration are limited with varying results in prior studies. METHODS This is a retrospective analysis using patients from ASCEND-HF with a stable diuretic strategy in the first 24 hours following randomization. Patients were divided into three groups: intravenous (IV) continuous, IV bolus and oral strategy. Baseline characteristics, in-hospital outcomes, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality were compared across groups. Inverse propensity weighted modeling was used for adjustment. RESULTS Among 5,738 patients with a stable diuretic regimen in the first 24 hours (80% of overall ASCEND trial), 3,944 (68.7%) patients received IV intermittent bolus administration of diuretics, 799 (13.9%) patients received IV continuous therapy and 995 (17.3%) patients with oral administration. Patients in the IV continuous group had a higher baseline creatinine (IV continuous 1.4 [1.1-1.7]; intermittent bolus 1.2 [1.0-1.6]; oral 1.2 [1.0-1.4] mg/dL; P <0.001) and high NTproBNP (IV continuous 5,216 [2,599-11,603]; intermittent bolus 4,944 [2,339-9,970]; oral 3,344 [1,570-7,077] pg/mL; P <0.001). There was no difference between IV continuous and intermittent bolus group in weight change, total urine output and change in renal function till 10 days/discharge (adjusted P >0.05 for all). There was no difference in 30 day mortality and HF readmission (adjusted OR 1.08 [95%CI: 0.74, 1.57]; P = 0.701) and 180 days mortality (adjusted OR 1.04 [95%CI: 0.75, 1.43]; P = 0.832). CONCLUSION In a large cohort of patients with decompensated HF, there were no significant differences in diuretic-related in-hospital, or post-discharge outcomes between IV continuous and intermittent bolus administration. Tailoring appropriate diuretic strategy to different states of acute HF and congestion phenotypes needs to be further investigated.

中文翻译：

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早期利尿策略以及与急性心力衰竭住院和出院后结局的关系。

背景减轻充血是失代偿性心力衰竭(HF)住院期间的主要目标。然而，关于利尿剂给药的首选途径和策略的数据有限，在先前的研究中结果各不相同。方法 这是一项回顾性分析，使用来自 ASCEND-HF 的患者在随机化后的前 24 小时内采用稳定的利尿策略。患者被分为三组：静脉内 (IV) 连续、IV 推注和口服策略。比较了各组的基线特征、住院结果、30 天复合心血管死亡率或 HF 再住院率和 180 天全因死亡率。逆倾向加权模型用于调整。结果 在前 24 小时内采用稳定利尿方案的 5,738 名患者中（占 ASCEND 试验总体的 80%），3,944 名（68. 7%) 患者接受了利尿剂的 IV 间断推注给药，799 (13.9%) 名患者接受了 IV 连续治疗，995 (17.3%) 名患者接受了口服给药。IV 连续组患者的基线肌酐较高（IV 连续 1.4 [1.1-1.7]；间歇性推注 1.2 [1.0-1.6]；口服 1.2 [1.0-1.4] mg/dL；P <0.001）和高 NTproBNP（IV连续 5,216 [2,599-11,603]；间歇性推注 4,944 [2,339-9,970]；口服 3,344 [1,570-7,077] pg/mL；P <0.001）。直到 10 天/出院，IV 连续和间歇推注组在体重变化、总尿量和肾功能变化方面没有差异（所有调整 P > 0.05）。30 天死亡率和 HF 再入院率（调整后 OR 1.08 [95%CI：0.74, 1.57]；P = 0.701）和 180 天死亡率（调整后 OR 1.04 [95%CI: 0.75, 1.43]）没有差异；P = 0.832）。结论 在一大群失代偿性 HF 患者中，IV 连续和间歇性推注给药之间利尿剂相关的院内或出院后结果没有显着差异。需要进一步研究针对不同急性 HF 状态和充血表型制定适当的利尿策略。