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Acute Decompensated Heart Failure (ADHF)NCT07464249

Comparison of the Effectiveness of Different Diuretic Therapies in the Management of Acute Heart Failure

A study testing Furosemide Bolus and Furosemide Continuous İnfusion in people with Acute Decompensated Heart Failure (ADHF), run by Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Acute decompensated heart failure (ADHF) is a clinical syndrome associated with high morbidity and mortality rates. Current guidelines emphasize the importance of oxygenation and diuresis in the management of ADHF. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Acute Decompensated Heart Failure (ADHF)
What is being tested?
Furosemide Bolus and Furosemide Continuous İnfusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteTurkey (Türkiye)
Study dates
3 Apr 2024to 30 Sep 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Age ≥18 years
  • Established diagnosis of heart failure
  • Presentation with acute decompensation meeting AHA/ACC Stage C-D criteria
  • New York Heart Association (NYHA) Class III-IV functional status at admission

Who cannot join

  • Known chronic kidney disease
  • Hemodynamic instability at presentation
  • Development of advanced airway requirement during follow-up
  • Requirement for emergent dialysis

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Sultan 2. Abdulhamid Han Research and Training Hospital

    Istanbul

Other trials in Turkey (Türkiye)

About this study

Official title: Comparison of the Effectiveness of Bolus and Infusion Diuretic Therapy in the Management of Acute Heart Failure in Emergency Departments: a Randomised, Double-blind Clinical Study

Acute decompensated heart failure (ADHF) is a clinical syndrome associated with high morbidity and mortality rates. Current guidelines emphasize the importance of oxygenation and diuresis in the management of ADHF. However, there is no clear recommendation regarding whether diuretic therapy should be administered as intermittent bolus dosing or continuous infusion. The aim of this study was to compare the early efficacy of bolus versus continuous infusion diuretic therapy in the emergency department management of ADHF. In this single-center, prospective, randomized, double-blind, parallel-group clinical trial, patients aged ≥18 years presenting with ADHF and without known chronic kidney disease were randomized in a 1:1 ratio to receive either intermittent bolus therapy or continuous infusion therapy. Allocation concealment was ensured using opaque sealed envelopes. To maintain blinding, simultaneous placebo-like administrations were performed in both groups. The primary endpoint was total urine output at 2 and 4 hours. Secondary endpoints included changes in the internal jugular vein collapsibility index (JVCI) at 2 and 4 hours. Tertiary end point was spot urinary sodium at 2 and 4 hours.

Read the detailed description

Acute decompensated heart failure (ADHF) is a common cause of emergency department admission and is associated with significant morbidity and mortality. Intravenous loop diuretics remain the cornerstone of treatment for patients presenting with volume overload. However, the optimal method of administration-intermittent bolus versus continuous infusion-remains controversial.

Most randomized studies comparing these strategies have been conducted in hospitalized patients and have focused on outcomes measured over longer observation periods. Data evaluating the early response to diuretic therapy in the emergency department setting are limited.

This prospective, randomized, double-blind clinical study aimed to compare the early effects of intravenous bolus versus continuous infusion furosemide therapy in patients presenting to the emergency department with acute decompensated heart failure.

Eligible patients were randomly assigned to receive either intermittent intravenous bolus furosemide or continuous infusion furosemide. Blinding was achieved by administering placebo infusion or placebo bolus according to treatment allocation. The primary outcome of the study was cumulative urine output during the first four hours after treatment initiation. Secondary outcomes included changes in the internal jugular vein collapsibility index measured by bedside ultrasound. The tertiary outcome was the spot urinary sodium at 2nd and 4th hours of study The study also evaluated the potential role of internal jugular vein collapsibility index as a dynamic and non-invasive parameter for monitoring systemic congestion during early diuretic therapy in the emergency department.

Being tested
Furosemide Bolus, Furosemide Continuous İnfusion
Keywords
acute decompensated heart failure, diuretics, furosemide, Jugular venous collapsibilty index, natriuresis, spot urinary sodium

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Furosemide BolusDrug

    Also called Bolus diuretics

    atients in this group received 2.5 times their usual daily diuretic dose administered as an intravenous bolus infusion

  • Furosemide Continuous İnfusionDrug

    Also called continuous infusion diuretics

    Patients in this group received 2.5 times their usual daily diuretic dose administered as an intravenous continious infusion

Study groups in NCT07464249
Study groupRoleWhat they receive
Bolus GroupExperimentalPatients in this group received an intravenous bolus equivalent to 2.5 times their total daily oral diuretic dose in 10mL syringe. Blinding was ensured by administering 100 mL of intravenous continuous infusion normal saline as a placebo.
Receives: Drug: Furosemide Bolus
İnfusion GroupExperimentalPatients in this group received an intravenous continious infusion equivalent to 2.5 times their total daily oral diuretic dose in 100mL saline bag. Blinding was ensured by administering 10 mL syringe of intravenous bolus normal saline as a placebo.
Receives: Drug: Furosemide Continuous İnfusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Diuresis

    Total cumulative urine output

    Measured: 2nd and 4th hours after administration of Furosemide

Secondary outcomes (1)
  1. Juguler Venous Collapsibility Index Change

    Change from baseline in internal jugular vein collapsibility index (JVCI) at 2 and 4 hours, measured by bedside ultrasonography.

    Measured: after administration of furosemide, 2nd and 4th hour

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Mar 2026
  2. Study start3 Apr 2024
  3. Primary completion30 Sep 2024
  4. Study completion30 Sep 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07464249
Sponsor's protocol ID
ECevik2
Status last verified
Mar 2026
First submitted
6 Mar 2026
Last updated
11 Mar 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Study protocol will be shared but Our clinical datas' are not available for sharig considering ethical problems.

Publications

  • Tersalvi G, Dauw J, Gasperetti A, Winterton D, Cioffi GM, Scopigni F, Pedrazzini G, Mullens W. The value of urinary sodium assessment in acute heart failure. Eur Heart J Acute Cardiovasc Care. 2021 Apr 8;10(2):216-223. doi: 10.1093/ehjacc/zuaa006.

    PubMed 33620424
  • Zheng Z, Jiang X, Chen J, He D, Xie X, Lu Y. Continuous versus intermittent use of furosemide in patients with heart failure and moderate chronic renal dysfunction. ESC Heart Fail. 2021 Jun;8(3):2070-2078. doi: 10.1002/ehf2.13286. Epub 2021 Mar 10.

    PubMed 33689236
  • Suri SS, Pamboukian SV. Optimal diuretic strategies in heart failure. Ann Transl Med. 2021 Mar;9(6):517. doi: 10.21037/atm-20-4600.

    PubMed 33850914
  • Fatima S, Lambert W, Nouraie M, Pacella J. Bedside ultrasound to assess acute central venous pressure change during treatment of decompensated heart failure. Int J Cardiol Heart Vasc. 2022 Jun 2;41:101067. doi: 10.1016/j.ijcha.2022.101067. eCollection 2022 Aug.

    PubMed 35676916
  • Tzadok B, Shapira S, Tal-Or E. Ultrasound of Jugular Veins for Assessment of Acute Dyspnea in Emergency Departments and for the Assessment of Acute Heart Failure. Isr Med Assoc J. 2018 May;20(5):308-310.

    PubMed 29761678
  • Jassim HM, Naushad VA, Khatib MY, Chandra P, Abuhmaira MM, Koya SH, Ellitthy MSA. IJV collapsibility index vs IVC collapsibility index by point of care ultrasound for estimation of CVP: a comparative study with direct estimation of CVP. Open Access Emerg Med. 2019 Apr 3;11:65-75. doi: 10.2147/OAEM.S176175. eCollection 2019.

    PubMed 31040727
  • Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419.

    PubMed 21366472
  • Ng KT, Yap JLL. Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials. Anaesthesia. 2018 Feb;73(2):238-247. doi: 10.1111/anae.14038. Epub 2017 Sep 22.

    PubMed 28940440
  • Karedath J, Asif A, Tentu N, Zahra T, Batool S, Sathish M, Sandhu QI, Khan A. Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis. Cureus. 2023 Feb 8;15(2):e34758. doi: 10.7759/cureus.34758. eCollection 2023 Feb.

    PubMed 36909062
  • Alqahtani F, Koulouridis I, Susantitaphong P, Dahal K, Jaber BL. A meta-analysis of continuous vs intermittent infusion of loop diuretics in hospitalized patients. J Crit Care. 2014 Feb;29(1):10-7. doi: 10.1016/j.jcrc.2013.03.015. Epub 2013 May 14.

    PubMed 23683555
  • Huang Y, Guo F, Chen D, Lin H, Huang J. Comparison of Different Furosemide Regimens in the Treatment of Acute Heart Failure: A Meta-Analysis. Comput Math Methods Med. 2022 Aug 18;2022:4627826. doi: 10.1155/2022/4627826. eCollection 2022.

    PubMed 36035285
  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. No abstract available.

    PubMed 34447992
  • Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-e421. doi: 10.1016/j.jacc.2021.12.012. Epub 2022 Apr 1.

    PubMed 35379503
  • Korkmaz HK, Gungor AC, Cevik E. Early effects of bolus versus continuous infusion furosemide in acute decompensated heart failure: a randomized double-blind study. Am J Emerg Med. 2026 Aug 16;110:111-116. doi: 10.1016/j.ajem.2026.08.009. Online ahead of print.

    PubMed 42624047

Questions about this trial

What is this clinical trial studying?

A study testing Furosemide Bolus and Furosemide Continuous İnfusion in people with Acute Decompensated Heart Failure (ADHF), run by Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Diuresis (time frame: 2nd and 4th hours after administration of Furosemide). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07464249, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2026; AzTrials last refreshed its copy on 8 Nov 2026.

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