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Diuretic Strategies in Patients with Acute Decompensated Heart Failure

Methodology: 3.5/5
Usefulness: 2/5
Felker GM, et al. NHLBI Heart Failure Clinical Research Network.
N Engl J Med. 2011 Mar 3;364(9):797-805

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This double-blind double-dummy RCT (N=308) found that there was no difference in the patient global assessment of symptoms between furosemide infusion vs bolus (mean AUC, 4236±1440 and 4373±1404, respectively; P = 0.47), low dose vs high dose (mean AUC, 4430±1401 vs. 4171±1436; P = 0.06) and also no difference between the groups with regard to creatinine level at 72 hours. The group felt that this study is not practice changing for emergency medicine and had several problems (less sick patients not requiring vasodilators and O2 sat 96%; randomization occurred 14 hours after presentation; use of NIPPV not mentioned).  
By: Dr. Bader Al Yahya
(Presented June 2013)
 
Epi Lesson: Use of Continuous Data as Primary Outcome   
Beware of studies that compare the effectiveness of interventions by using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain relief. These kinds of data can produce statistically significant differences between groups with relatively small sample sizes but often give you little information about clinical importance. Far better and almost always the norm are outcome measures given as proportions or percentages, such as % of patients who achieve: 20 points improvement in pain, an oxygen saturation of 90%, pain relief in less than 2 hours, or survival. 
By Dr. Ian Stiell   

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