Hypertonic saline solution and IV furosemide improve outcomes in acute heart failure: Study

Acute decompensated heart failure (ADHF) is a condition which leads to sudden or gradual onset of heart failure signs and symptoms mostly witnessed by physicians working in the emergency ward. It is characterized by the excessive fluid overload often referred to as pulmonary edema, in the lung interstitium and alveolar spaces.

A study was conducted by Chang Liu et. al to assess the efficiency of the concomitant use of the hypertonic saline solution and IV furosemide for patients with fluid overload as compared to the use of IV furosemide alone.

The researchers selected a total of 2987 adult patients with fluid overload and divided them into two groups; one group was treated simultaneously with hypertonic saline solution and IV furosemide while the other group was treated with IV furosemide alone. Further randomized controlled trials were conducted on these two groups. Additionally, they collected extensive data related to mortality rates, length of hospital stay, inpatient weight loss, etc.

Participants who were treated by simultaneous use of the hypertonic saline solution and IV furosemide showed the following findings as compared to the ones who were treated with IV furosemide alone:

• Lower all-cause mortality (relative risk, 0.55; 95% CI, 0.46–0.67; p < 0.05; I2 = 12%).
• Reduced incidences of heart failure–related readmissions (relative risk, 0.50; 95% CI, 0.33–0.76; p < 0.05; I2 = 61%)
• Decreased hospital length of stay (mean difference, –3.28 d; 95% CI, –4.14 to –2.43; p < 0.05; I2 = 93%)
• Increased daily diuresis (mean difference, 583.87 mL; 95% CI, 504.92–662.81; p < 0.05; I2 = 76%)
• Decreased weight loss (mean difference, –1.76 kg; 95% CI, –2.52 to –1.00; p < 0.05; I2 = 57%)
• Improved serum sodium change (mean difference, 6.89 mEq/L; 95% CI, 4.98–8.79; p < 0.05; I2 = 95%)
• Higher 24-hour urine sodium excretion (mean difference, 61.10 mEq; 95% CI, 51.47–70.73; p < 0.05; I2 = 95%)
• Decreased serum creatinine (mean difference, –0.46 mg/dL; 95% CI, –0.51 to –0.41; p < 0.05; I2 = 89%)

The certainty of all the findings ranged from low to moderate.

The authors concluded that the treatment with concomitant use of the hypertonic saline solution and IV furosemide had superior outcomes in all the observed outcomes in the selected patients with acute decompensated heart failure patients with fluid overload.

Reference:

A study titled, "Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload A Systematic Review and Meta-Analysis" by Chang Liu et. al published in the Critical Care Medicine journal.

https://journals.lww.com/ccmjournal/abstract/9000/simultaneous_use_of_hypertonic_saline_and_iv.95182.aspx