Loop Diuretics for Decompensated Heart Failure

Abstract This chapter appraises the DOSE study, which examined the use of loop diuretics in acute decompensated heart failure. The study compared the effects of different intravenous diuretic doses and administration methods, focusing on high-dose vs. low-dose and bolus vs. continuous infusion. The chapter shows that higher doses of loop diuretics enhance diuresis but temporarily increase creatinine levels, which typically does not require de-escalation. The study highlighted that bolus dosing achieves similar outcomes to continuous infusion while presenting fewer logistical challenges for patients. Finally, the chapter discusses that the DOSE trial has shaped clinical practices by confirming the safety and efficacy of diuretic dosing strategies, particularly for hemodynamically stable patients, though it acknowledges limitations in generalizability and dosing practices.