Continuous Infusion Versus Intermittent Boluses of Furosemide in Acute Heart Failure: A Systematic Review and Meta-Analysis

Background: Acute heart failure is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute heart failure. Methods: Electronic searches were performed on PubMed, Medline, Scopus, and EMBASE. English articles comparing intermittent boluses and continuous infusion of furosemide in treating acute heart failure were included. Non-comparative studies or articles, and articles that did not report specific data for acute heart failure patients were excluded. Primary endpoints included post-treatment daily urine output, weight, length of stay, and serum sodium, potassium, and creatinine. Secondary endpoints included other pre-treatment and treatment variables. Post hoc trial sequential analysis (TSA) was performed on selected variables. Results: Ten randomized controlled trials were included with a total of 735 patients (371 with intermittent boluses and 364 with continuous infusion). Mean daily urine output (P < .001) and weight loss (P = .04) were significantly higher in the continuous infusion group. Other variables were not significantly different between the two groups. TSA showed that current evidence is sufficient to draw the above conclusions about mean daily urine output, but more studies were required to compare the 2 regimens in terms of weight loss. Conclusion: Choice of furosemide regime in acute heart failure remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.