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The Effect of Furosemide Dose Administered in the Out-of-hospital Setting on Renal Function Among Patients with Suspected Acute Decompensated Heart Failure

Published online by Cambridge University Press:  16 January 2015

L. Celeste Nieves ,
Gia M. Mehrtens ,
Noah Pores ,
Christie Pickrell ,
James Tanis ,
Timothy Satty ,
Michelle Chuang ,
Tina C. Young  and
Mark A. Merlin
L. Celeste Nieves*
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey USA
Gia M. Mehrtens
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA Ochsner Health System, Emergency Medicine, New Orleans, Louisiana USA
Noah Pores
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA Ochsner Health System, Emergency Medicine, New Orleans, Louisiana USA
Christie Pickrell
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA
James Tanis
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA
Timothy Satty
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA
Michelle Chuang
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA
Tina C. Young
Affiliation:
Department of Biostatistics, Rutgers School of Public Health, Piscataway, New Jersey USA
Mark A. Merlin
Affiliation:
Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA EMS and Disaster Medicine, Newark Beth Israel Medical Center, Newark, New Jersey USA
*
Correspondence: L. Celeste Nieves, MD, MS Department of Emergency Medicine Saint Joseph's Regional Medical Center 201 Main St. Paterson, New Jersey 07503 USA E-mail Lceleste.nieves@gmail.com
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Abstract

Background

The most effective dose of prehospital furosemide in acute decompensated heart failure (ADHF) has not yet been identified and concerns of worsening renal function have limited its use.

Objective

To assess if administering high-dose furosemide is associated with worsening renal function.

Methods

The authors conducted a 2-center chart review for patients who presented via a single Emergency Medical Service (EMS) from June 5, 2009 through May 17, 2013. Inclusion criteria were shortness of breath, primarily coded as ADHF, and the administration of furosemide prior to emergency department (ED) arrival. A total of 331 charts were identified. The primary endpoint was an increase in creatinine (Cr) of more than 0.3 mg/dL from admission to any time during hospital stay. Exploratory endpoints included survival, length-of-stay (LOS), disposition, urine output in the ED, change in BUN/Cr from admission to discharge, and change in Cr from admission to 72 hours and discharge.

Results

When treated as a binary variable, there was no association observed between an increase in Cr of more than 0.3 mg/dL and prehospital furosemide dose. Baseline characteristics found to be associated with dose were included in the logistic regression model. Lowering the dose of prehospital furosemide was associated with higher odds of attaining a 0.3 mg/dL increase in Cr (adjusted OR = 1.49 for a 20 mg decrease; P = .019). There was no association found with any of the exploratory endpoints.

Conclusions

Patients who received higher doses of furosemide prehospitally were less likely to have an increase of greater than 0.3 mg/dL in Cr during the hospital course.

NievesLC, MehrtensGM, PoresN, PickrellC, TanisJ, SattyT, ChuangM, YoungTC, MerlinMA. The Effect of Furosemide Dose Administered in the Out-of-hospital Setting on Renal Function Among Patients with Suspected Acute Decompensated Heart Failure. Prehosp Disaster Med. 2015;30(1):1-8.

Keywords

furosemideheart failureprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 1 , February 2015 , pp. 38 - 45
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2015 

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Footnotes

Conflicts of interest: none

References

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