Home›Cardiology› Continuous intravenous furosemide improves freedom from congestion compared to intermittent bolus administration
Continuous intravenous furosemide improves freedom from congestion compared to intermittent bolus administrationContinuous Furosemide May Improve Congestion in Heart Failure Patients
Frontiers in MedicinePublished July 2, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider continuous intravenous furosemide for faster relief of congestion and lower post-treatment BNP levels.
This meta-analysis evaluates the efficacy of continuous intravenous (cIV) furosemide compared to intermittent intravenous (iIV) bolus furosemide in 2,633 adult patients with acute heart failure or NYHA class III-IV symptoms. The study focuses on primary outcomes including all-cause mortality and freedom from congestion, alongside several secondary measures of clinical improvement.
The analysis found significant improvements in the cIV arm for freedom from congestion (RR: 1.42; 95% CI: 1.06-1.91, p = 0.02). While a numerical trend toward higher all-cause mortality was noted in the iIV arm (RR: 1.36; 95% CI: 0.96-1.94, p = 0.08), this did not reach statistical significance. Other significant improvements for cIV included weight loss, 24-h urine volume, length of hospital stay, edema resolution time, time to dyspnea improvement, post-treatment LVEF, and post-treatment LVEDD.
Several limitations were noted regarding the quality of evidence. The authors reported low evidence quality for all-cause mortality, 24-h urine volume, length of hospital stay, edema resolution time, time to dyspnea improvement, post-treatment LVEF, and post-treatment LVEDD. Evidence for freedom from congestion, weight loss, and post-treatment BNP level was moderate. Clinical practice relevance is centered on the finding that continuous infusion may offer faster relief of congestion and greater reduction in post-treatment BNP levels compared to bolus administration.
How this fits prior evidence
This meta-analysis addresses a gap in optimizing diuretic delivery for acute heart failure. It complements existing evidence regarding sacubitril/valsartan improving LVEF and NT-proBNP levels in specific heart failure populations and the use of interval likelihood ratios to improve management decisions in heart failure. While this study focuses on the administration method of furosemide, it provides a different clinical pathway for managing congestion compared to the pharmacological interventions or diagnostic tools mentioned in prior coverage.
Researchers looked at how different ways of giving the medication furosemide affect adults with acute heart failure. They compared a continuous intravenous infusion to the common method of giving the medicine in intermittent bolus doses. The study included data from 2,633 patients.
The results showed that patients receiving the continuous infusion had significant improvements in several areas. These included faster relief from congestion, more weight loss, and lower levels of a heart stress marker called BNP. Patients also saw faster improvement in breathing and quicker resolution of swelling (edema). While there was a trend toward fewer deaths in the continuous group, this specific finding was not statistically certain.
It is important to note that many of these findings have low evidence quality because they were based on limited data types. The study did not report any specific safety concerns or side effects for either method. Because the evidence is mixed and some results are less certain, patients should talk to their doctors about which treatment plan is best for their specific condition.
What this means for you:
Continuous furosemide may help heart failure patients clear fluid faster, but more high-quality data is needed.
Common questions
How does continuous furosemide differ from standard treatment?
Standard treatment often uses intermittent bolus doses. This study compared that to a continuous intravenous infusion. The continuous method showed significant improvements in weight loss, 24-hour urine volume, and the time it took for patients to feel better and experience less swelling.
Does this treatment help with breathing issues?
Yes, the data showed that patients receiving a continuous infusion had a faster time to dyspnea improvement. This means they experienced relief from shortness of breath more quickly than those receiving intermittent doses.
Is it proven to increase survival rates?
The study found a numerical trend toward lower mortality for patients on continuous infusion, but this result was not statistically significant. Because the evidence quality for all-cause mortality is low, it cannot be confirmed as a definitive benefit.
IntroductionAcute heart failure is defined as the rapid or gradual onset of signs and/or symptoms of heart failure severe enough to warrant unplanned hospital or emergency department care. As of 2019, an estimated 56.2 million individuals across 204 countries and territories were living with heart failure; data gaps suggest the true burden is likely higher. The global number of HF cases doubled from 27.2 million in 1990 to 56.2 million in 2019, with a parallel doubling observed in both sexes. Intravenous loop diuretics—predominantly furosemide—constitute the cornerstone of decongestive therapy, yet the optimal dosing strategy is still debated. Previous studies have established the framework for this field but yielded conflicting conclusions. In addition, those studies had some limitations. Therefore, we conducted an updated systematic review and meta-analysis that identified and included all RCTs comparing continuous infusion with intermittent bolus furosemide in adult patients with acute heart failure or NYHA class III–IV symptoms.MethodsWe conducted a systematic literature search in PubMed, Embase, the Cochrane Library, CNKI, Wan Fang, and VIP databases for relevant studies published up to 1 October 2025. RCTs comparing continuous infusion with intermittent bolus furosemide in adult patients with acute heart failure or NYHA class III–IV symptoms were included. Primary endpoints were all-cause mortality and freedom from congestion. Secondary endpoints were weight loss, 24-h urine volume, length of hospital stay, 72-h urine volume, post-treatment BNP, edema resolution time, time to dyspnea improvement, post-treatment LVEF, and post-treatment LVEDD.ResultsA total of 22 RCTs with 2,633 participants were included. The intermittent intravenous (iIV) arm showed a numerical trend toward all-cause mortality without reaching statistical significance (low evidence quality) compared with the continuous intravenous (cIV) arm (RR: 1.36, 95% CI: 0.96–1.94, p = 0.08). The cIV arm demonstrated significant improvements in freedom from congestion (moderate evidence quality) compared with the iIV arm (RR: 1.42, 95% CI: 1.06–1.91, p = 0.02). In addition, the cIV arm showed significant improvements in weight loss (moderate evidence quality), 24-h urine volume (low evidence quality), length of hospital stay (low evidence quality), edema resolution time (low evidence quality), time to dyspnea improvement (low evidence quality), post-treatment LVEF (low evidence quality), post-treatment LVEDD (low evidence quality), and post-treatment BNP level (moderate evidence quality).DiscussionCompared with intravenous bolus furosemide, continuous infusion was associated with faster relief of congestion, greater weight loss, and greater reduction in post-treatment BNP levels (moderate evidence quality). However, no significant advantage was demonstrated for the remaining outcomes or long-term survival, as judged by the quality of evidence and effect estimates.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420260223267, identifier CRD420260223267.
