DOSE

Clinical question

In acute decompensated heart failure, does the route (bolus vs. continuous infusion) or dose intensity (low- vs. high-dose) of IV furosemide affect symptom relief or renal function?

What the trial found

Neither the route of furosemide administration (bolus vs. continuous) nor the dose intensity (low vs. high) significantly changed symptom relief or renal function at 72 hours, though the high-dose strategy showed trends toward greater diuresis and symptom relief at the cost of a trend toward transient renal function worsening, neither reaching statistical significance.

Clinical interpretation

DOSE supports flexibility in diuretic strategy for acute decompensated heart failure — neither administration route nor dose intensity has been shown to be clearly superior, so the choice can reasonably be guided by institutional practice and individual patient response rather than a single mandated protocol.

Limitations

• Restricted to patients with at least moderate baseline diuretic requirements; may not generalize to diuretic-naive patients.
• Underpowered to detect smaller differences between strategies given the observed (nonsignificant) trends.