The effects of a sliding scale diuretic titration protocol in patients with heart failure

Marilyn A. Prasun, Abraham G. Kocheril, Patricia H. Klass, Stephanie Hope Dunlap, Mariann R. Piano

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Patients with heart failure (HF) are often instructed to temporarily adjust their diuretic dose. This approach has become routine in some HF management programs; however, no study has specifically examined the effects of a patient-directed flexible diuretic protocol. For the purposes of this study, patients were randomized into a usual care (UC) group (n = 31) or a flexible diuretic titration (DT) group (n = 35). The DT group completed a 6-item diuretic titration protocol once a day, for 3 months. The 6-minute walk distance, plasma B-type natriuretic peptide (NT-BNP), plasma norepinephrine (NE), and quality of life (QOL) were measured at baseline and at 3 months. Hospitalizations, emergency department (ED) visits, and mortality rates were measured at 3 months. Compared to baseline, at 3 months, there was a significant increase in the DT group's 6-minute walk distance (646 60 ft vs 761 61 ft, P =.01) and total QOL score (53 5 vs 38 5, P =.001), whereas these parameters remained unchanged within the UC group. There were significantly less ED visits in the DT group compared with those in the UC group (3% vs 23%, P =.015). No differences were found between the groups in HF-related hospitalizations or mortality. Within both groups, no differences were found between baseline and 3-month NE or NT-BNP plasma values. Patients with heart failure who used a sliding scale diuretic titration protocol had significant improvements in their exercise tolerance and QOL, had fewer ED visits, and had no change in plasma NE or NT-BNP levels.

Original languageEnglish (US)
Pages (from-to)62-70
Number of pages9
JournalJournal of Cardiovascular Nursing
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Diuretics
Heart Failure
Hospital Emergency Service
Norepinephrine
Quality of Life
Hospitalization
Exercise Tolerance
Mortality
Brain Natriuretic Peptide
pro-brain natriuretic peptide (1-76)

Keywords

  • B-type natriuretic peptide
  • Diuretic titration
  • Diuretics
  • Exercise tolerance
  • Norepinephrine
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

The effects of a sliding scale diuretic titration protocol in patients with heart failure. / Prasun, Marilyn A.; Kocheril, Abraham G.; Klass, Patricia H.; Dunlap, Stephanie Hope; Piano, Mariann R.

In: Journal of Cardiovascular Nursing, Vol. 20, No. 1, 01.01.2005, p. 62-70.

Research output: Contribution to journalArticle

Prasun, Marilyn A. ; Kocheril, Abraham G. ; Klass, Patricia H. ; Dunlap, Stephanie Hope ; Piano, Mariann R. / The effects of a sliding scale diuretic titration protocol in patients with heart failure. In: Journal of Cardiovascular Nursing. 2005 ; Vol. 20, No. 1. pp. 62-70.
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