{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:16Z","timestamp":1782107356036,"version":"3.54.5"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute 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\u2014predominantly furosemide\u2014constitute 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\u2013IV symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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\u2013IV 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A 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\u20131.94,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009 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\u20131.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). 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).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Compared 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420260223267<\/jats:ext-link>\n                      , identifier CRD420260223267.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1792136","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:38:04Z","timestamp":1782106684000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy of continuous versus intermittent administration of furosemide in acute heart failure: an updated systematic review and meta-analysis of 22 RCTs"],"prefix":"10.3389","volume":"13","author":[{"given":"Juan","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Cardiology, Nantong Hospital of Traditional Chinese Medicine","place":["Nantong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danpeng","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affliliated Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Yang","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Yuan","sequence":"additional","affiliation":[{"name":"Sichuan Integrative Medicine Hospital","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","article-title":"Heart failure epidemiology and outcomes statistics: a report of the Heart Failure Society of America","volume":"29","author":"Bozkurt","year":"2023","journal-title":"J Card Fail"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.1161\/CIR.0000000000001209","article-title":"2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association","volume":"149","author":"Martin","year":"2024","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1186\/s12872-022-02781-9","article-title":"Prediction of rehospitalization in patients with acute heart failure using point-of-care lung ultrasound","volume":"22","author":"Rattarasarn","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e003210","DOI":"10.1136\/openhrt-2025-003210","article-title":"Predicting death or readmission following heart failure hospitalisation: the Vancouver CoastAL acute heart failure (VOCAL-AHF) registry","volume":"12","author":"Salimian","year":"2025","journal-title":"Open Heart"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.3390\/jcm13061674","article-title":"The changing role of loop diuretics in heart failure management across the last century","volume":"13","author":"Palazzuoli","year":"2024","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"CD003178","DOI":"10.1002\/14651858.CD003178","article-title":"Continuous infusion versus bolus injection of loop diuretics in congestive heart failure","volume":"2005","author":"Salvador","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e011105","DOI":"10.1161\/CIRCHEARTFAILURE.123.011105","article-title":"Protocolized natriuresis-guided decongestion improves diuretic response: the multicenter ENACT-HF study","volume":"17","author":"Dauw","year":"2024","journal-title":"Circ Heart Fail"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1016\/s0735-1097(02)01814-4","article-title":"Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure","volume":"39","author":"Johnson","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1378\/chest.102.3.725","article-title":"Intermittent administration of furosemide vs continuous infusion preceded by a loading dose for congestive heart failure","volume":"102","author":"Lahav","year":"1992","journal-title":"Chest"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.1002\/ehf2.13286","article-title":"Continuous versus intermittent use of furosemide in patients with heart failure and moderate chronic renal dysfunction","volume":"8","author":"Zheng","year":"2021","journal-title":"ESC Heart Fail"},{"key":"B11","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1111\/anae.14038","article-title":"Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials","volume":"73","author":"Ng","year":"2018","journal-title":"Anaesthesia"},{"key":"B12","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/j.cardfail.2019.11.013","article-title":"Continuous infusion versus intermittent boluses of furosemide in acute heart failure: a systematic review and meta-analysis","volume":"26","author":"Chan","year":"2020","journal-title":"J Card Fail"},{"key":"B13","doi-asserted-by":"publisher","first-page":"CD014811","DOI":"10.1002\/14651858.CD014811.pub2","article-title":"Continuous infusion versus bolus injection of loop diuretics for acute heart failure","volume":"5","author":"Rasoul","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"Br Med J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"273","DOI":"10.3109\/tcic.8.6.273.276","article-title":"Frusemide in pulmonary oedema: continuous versus intermittent","volume":"8","author":"Makhoul","year":"1997","journal-title":"Clini cal Intensive Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1794","DOI":"10.1016\/j.amjcard.2010.01.355","article-title":"Continuousversusbolusdosing offuro semide for patients hospitalized for heart failure","volume":"105","author":"Allen","year":"2010","journal-title":"Am J Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.cardfail.2009.11.005","article-title":"Continuous versus intermittent infusion of furosemide in acute decompensated heart failure","volume":"16","author":"Thomson","year":"2010","journal-title":"J Card Fail"},{"key":"B18","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1056\/NEJMoa1005419","article-title":"Diuretic strategies in patients with acute decompensated heart failure","volume":"364","author":"Felker","year":"2011","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1136\/emermed-2013-202526","article-title":"Clinical effects and safety of different strategies for administering intravenous diuretics in acutely decom pensated heart failure: a randomised clinical trial","volume":"31","author":"Llorens","year":"2014","journal-title":"Emerg Med J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"R134","DOI":"10.1186\/cc13952","article-title":"Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial","volume":"18","author":"Palazzuoli","year":"2014","journal-title":"Crit Care (London, England)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.ihj.2014.03.006","article-title":"A prospective, randomized study to evaluate the efficacy of various di uretic strategies in acute decompensated heart failure","volume":"66","author":"Shah","year":"2014","journal-title":"Indian Heart J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s00059-015-4327-y","article-title":"Comparison of three diuretic treatment strategies for patients with acute decom pensated heart failure","volume":"40","author":"Yayla","year":"2015","journal-title":"Herz"},{"key":"B23","first-page":"497","article-title":"Clinical observation of different furosemide administration methods in patients with acute heart failure and renal insufficiency","volume":"50","author":"Rongsheng","year":"2015","journal-title":"Jiangxi Med J"},{"key":"B24","first-page":"71","article-title":"Clinical efficacy observation of high-dose furosemide continuous intravenous infusion in the treatment of severe heart failure","volume":"16","author":"Yanmei","year":"2016","journal-title":"World Latest Med Inf"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3551","DOI":"10.21276\/sjams.2017.5.9.17","article-title":"Continuous versus bolus dosing of furosemide in the treatment of patients with acute decompensated heart failure","volume":"5","author":"Malkiwodeyar","year":"2017","journal-title":"Sch J Applied Med Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"13335","DOI":"10.16281\/j.cnki.jocml.2017.68.047","article-title":"Clinical observation of different furosemide administration methods in patients with acute heart failure and renal insufficiency","volume":"4","author":"Qi","year":"2017","journal-title":"J Clin Med Lit (Electron Ed"},{"key":"B27","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.ehj.2017.12.005","article-title":"Continuous infusion of furosemide versus intermittent boluses in acute decompensated heart failure: effect on thoracic fluid content","volume":"70","author":"Ragab","year":"2018","journal-title":"Egypt Heart J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"47","DOI":"10.16281\/j.cnki.jocml.2018.25.024","article-title":"Application of high-dose furosemide continuous intravenous infusion in the clinical treatment of patients with severe heart failure","volume":"5","author":"Kefeng","year":"2018","journal-title":"J Clin Med Lit (Electron Ed"},{"key":"B29","first-page":"1193","article-title":"Effects of different furosemide administration methods on acute heart failure complicated with renal dysfunction","volume":"53","author":"Rongsheng","year":"2018","journal-title":"Jiangxi Med J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"3977","DOI":"10.19435\/j.1672-1721.2018.28.034","article-title":"Efficacy observation of high-dose furosemide continuous intravenous infusion in the treatment of severe heart failure","volume":"22","author":"Hantao","year":"2018","journal-title":"Prim Med Forum"},{"key":"B31","first-page":"44","article-title":"Clinical efficacy analysis of high-dose furosemide continuous intravenous infusion in the treatment of severe heart failure","volume":"57","author":"Chengzhi","year":"2019","journal-title":"China Mod Doctor"},{"key":"B32","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00392-019-01521-y","article-title":"Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure-bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial","volume":"109","author":"Frea","year":"2020","journal-title":"Clin Res Cardiol"},{"key":"B33","first-page":"113","article-title":"Clinical efficacy of high-dose furosemide continuous intravenous infusion in patients with severe heart failure","volume":"16","author":"Haoyang","year":"2021","journal-title":"China J Pharm Econ"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e70033","DOI":"10.1002\/clc.70033","article-title":"Outcomes of bolus dose furosemide versus continuous infusion in patients with acute decompensated left ventricular failure and atrial fibrillation","volume":"47","author":"Khan","year":"2024","journal-title":"Clin Cardiol"},{"key":"B35","first-page":"76","article-title":"Effects of high-dose furosemide continuous intravenous infusion on cardiac function and exercise tolerance in patients with severe heart failure","volume":"48","author":"Chongqiang","year":"2025","journal-title":"Heilongjiang Med Pharm"},{"key":"B36","doi-asserted-by":"publisher","first-page":"4627826","DOI":"10.1155\/2022\/4627826","article-title":"Comparison of different furosemide regimens in the treatment of acute heart failure: a meta-analysis","volume":"2022","author":"Huang","year":"2022","journal-title":"Comput Math Methods Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"100465","DOI":"10.1016\/j.xkme.2022.100465","article-title":"Renin-angiotensin-aldosterone system activation and diuretic response in ambulatory patients with heart failure","volume":"4","author":"Amatruda","year":"2022","journal-title":"Kidney Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ijcard.2021.10.149","article-title":"Distinct renin\/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure","volume":"345","author":"Biegus","year":"2021","journal-title":"Int J Cardiol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s10741-018-9727-7","article-title":"Continuous versus intermittent administration of furosemide in acute decompensated heart failure: a systematic review and meta-analysis","volume":"24","author":"Kuriyama","year":"2019","journal-title":"Heart Fail Rev"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1792136\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:38:07Z","timestamp":1782106687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1792136\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":39,"alternative-id":["10.3389\/fcvm.2026.1792136"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1792136","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"article-number":"1792136"}}