Abstract
Hypertonic saline with furosemide has been proposed for a long time as an effective therapeutic option for the treatment of acute decompensated heart failure (ADHF). We previously reported the efficacy of continuous infusion of 1.7 % hypertonic saline plus low-dose furosemide in treatment for ADHF. Although this therapeutic strategy can be a useful option for effective decongestion in treatment for ADHF, there is no study that assesses the effect and safety of saline supplementation compared with standard therapy in Japan. The aim of this study was to investigate the efficacy, safety, and cost-effectiveness of 1.7 % hypertonic saline plus low-dose furosemide infusion compared with carperitide. We compared clinical outcomes, adverse events, and cost for patients receiving carperitide (carperitide group) with those for patients receiving 1.7 % hypertonic saline plus low-dose furosemide (salt group) during the initial hospitalization for ADHF. The cost analysis was performed on the basis of the previous report about cost-effectiveness of acute heart failure. A total of 175 ADHF patients received either carperitide (n = 111) or 1.7 % hypertonic saline plus low-dose furosemide infusion (n = 64) as initial treatment. There were no differences in length of hospital stay (27 ± 19 vs. 25 ± 16 day, p = 0.170) and infusion period (7.2 ± 6.1 vs. 8.4 ± 7.5 day, p = 0.474) between the two groups. The incidence of rehospitalization did not differ at 1 month (7.6 vs. 6.6 %, p = 1.000) and 1 year (36.8 vs. 37.7 %, p = 0.907) between the two groups. The Kaplan–Meier curves revealed no significant difference for 1 year all-cause mortality between the two groups (log-rank, p = 0.724). The single hospitalization cost was 95,314 yen lower and the yearly hospitalization cost 125,628 yen lower in the salt group compared with the carperitide group. Thus, intravenous 1.7 % hypertonic saline plus low-dose furosemide infusion is as effective as carperitide in terms of clinical outcome and is a cost-effective therapeutic strategy for the treatment of ADHF.
Similar content being viewed by others
References
Licata G, Di Pasquale P, Parrinello G, Cardinale A, Scandurra A, Follone G, Argano C, Tuttolomondo A, Paterna S (2003) Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J 145:459–466
De Vecchis R, Esposito C, Ariano C, Cantatrione S (2015) Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure: a meta-analysis of the literature. Herz 40:423–435
Gandhi S, Mosleh W, Myers RB (2014) Hypertonic saline with furosemide for the treatment of acute congestive heart failure: a systematic review and meta-analysis. Int J Cardiol 173:139–145
Parrinello G, Di Pasquale P, Licata G, Torres D, Giammanco M, Fasullo S, Mezzero M, Paterna S (2009) Long-term effects of dietary sodium intake on cytokines and neurohormonal activation in patients with recently compensated congestive heart failure. J Card Fail 15:864–873
Volpe M, Magri P, Rao MA, Cangianiello S, DeNicola L, Mele AF, Memoli B, Enea I, Rubattu S, Gigante B, Trimarco B, Epstein M, Condorelli M (1997) Intrarenal determinants of sodium retention in mild heart failure: effects of angiotensin-converting enzyme inhibition. Hypertension 30:168–176
Okuhara Y, Hirotani S, Naito Y, Nakabo A, Iwasaku T, Eguchi A, Morisawa D, Ando T, Sawada H, Manabe E, Masuyama T (2014) Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure. J Card Fail 20:295–301
Yamamoto Y, Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Yamamoto M, Tsurumi M, Matsushita M, Okazaki H, Yokoyama S, Asai K, Mizuno K, Shimizu W (2015) Seasonal variation in patients with acute heart failure: prognostic impact of admission in the summer. Heart Vessel 30:193–203
Matsukawa R, Kubota T, Okabe M, Yamamoto Y (2015) Early use of V2 receptor antagonists is associated with a shorter hospital stay and reduction in in-hospital death in patients with decompensated heart failure. Heart Vessel. doi:10.1007/s00380-015-0780-z
Sato N, Kajimoto K, Asai K, Mizuno M, Minami Y, Nagashima M, Murai K, Muanakata R, Yumino D, Meguro T, Kawana M, Nejima J, Satoh T, Mizuno K, Tanaka K, Kasanuki H, Takano T, Investigators A (2010) Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: rationale, design, and preliminary data. Am Heart J 159(949–955):e941
Fujita S, Shimojo N, Terasaki F, Otsuka K, Hosotani N, Kohda Y, Tanaka T, Nishioka T, Yoshida T, Hiroe M, Kitaura Y, Ishizaka N, Imanaka-Yoshida K (2013) Atrial natriuretic peptide exerts protective action against angiotensin II-induced cardiac remodeling by attenuating inflammation via endothelin-1/endothelin receptor A cascade. Heart Vessel 28:646–657
Ishikawa C, Tsutamoto T, Wada A, Fujii M, Ohno K, Sakai H, Yamamoto T, Horie M (2005) Inhibition of aldosterone and endothelin-1 by carperitide was attenuated with more than 1 week of infusion in patients with congestive heart failure. J Cardiovasc Pharmacol 46:513–518
Hattori H, Minami Y, Mizuno M, Yumino D, Hoshi H, Arashi H, Nuki T, Sashida Y, Higashitani M, Serizawa N, Yamada N, Yamaguchi J, Mori F, Shiga T, Hagiwara N (2013) Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes. Heart Vessel 28:345–351
Suwa M, Seino Y, Nomachi Y, Matsuki S, Funahashi K (2005) Multicenter prospective investigation on efficacy and safety of carperitide for acute heart failure in the ‘real world’ of therapy. Circ J 69:283–290
Fedele F, D’Ambrosi A, Bruno N, Caira C, Brasolin B, Mancone M (2011) Cost-effectiveness of levosimendan in patients with acute heart failure. J Cardiovasc Pharmacol 58:363–366
Zepeda P, Rain C, Sepulveda P (2015) What are the effects of hypertonic saline plus furosemide in acute heart failure? Medwave 15(Suppl 2):e6233
Hata N, Seino Y, Tsutamoto T, Hiramitsu S, Kaneko N, Yoshikawa T, Yokoyama H, Tanaka K, Mizuno K, Nejima J, Kinoshita M (2008) Effects of carperitide on the long-term prognosis of patients with acute decompensated chronic heart failure: the PROTECT multicenter randomized controlled study. Circ J 72:1787–1793
Suzuki S, Yoshihisa A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Abe Y, Saito T, Ohwada T, Suzuki H, Saitoh S, Kubota I, Takeishi Y, investigators A (2013) Acute heart failure volume control multicenter randomized (AVCMA) trial: comparison of tolvaptan and carperitide. J Clin Pharmacol 53:1277–1285
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 (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797–805
Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM, Emerman CL (2009) Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry. Cardiology 113:12–19
Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP (2010) Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation 122:265–272
Voors AA, Davison BA, Teerlink JR, Felker GM, Cotter G, Filippatos G, Greenberg BH, Pang PS, Levin B, Hua TA, Severin T, Ponikowski P, Metra M (2014) Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome–an analysis from RELAX-AHF. Eur J Heart Fail 16:1230–1240
Palazzuoli A, Ruocco G, Ronco C, McCullough PA (2015) Loop diuretics in acute heart failure: beyond the decongestive relief for the kidney. Crit Care 19:296
Matsue Y, Shiraishi A, Kagiyama N, Yoshida K, Kume T, Okura H, Suzuki M, Matsumura A, Yoshida K, Hashimoto Y (2016) Renal function on admission modifies prognostic impact of diuretics in acute heart failure: a propensity score matched and interaction analysis. Heart Vessel. doi:10.1007/s00380-016-0817-y
Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, Stough WG, Yancy CW, Young JB, Fonarow GC (2006) Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 296:2217–2226
Takaya Y, Yoshihara F, Yokoyama H, Kanzaki H, Kitakaze M, Goto Y, Anzai T, Yasuda S, Ogawa H, Kawano Y (2016) Impact of onset time of acute kidney injury on outcomes in patients with acute decompensated heart failure. Heart Vessel 31:60–65
Shorr AF, Tabak YP, Johannes RS, Gupta V, Saltzberg MT, Costanzo MR (2011) Burden of sodium abnormalities in patients hospitalized for heart failure. Congest Heart Fail 17:1–7
Parissis J, Athanasakis K, Farmakis D, Boubouchairopoulou N, Mareti C, Bistola V, Ikonomidis I, Kyriopoulos J, Filippatos G, Lekakis J (2015) Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital. Int J Cardiol 180:46–49
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
This research received no Grant from any funding agency in the public, commercial, or non-profit sectors.
Rights and permissions
About this article
Cite this article
Okuhara, Y., Hirotani, S., Ando, T. et al. Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure: a single-center retrospective cohort study. Heart Vessels 32, 419–427 (2017). https://doi.org/10.1007/s00380-016-0883-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-016-0883-1