Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial
Dopamine in Acute Decompensated Heart Failure (DAD-HF) Trial
The aim of this study is to compare the effects of high-dose furosemide versus low-dose
 furosemide combined with low-dose dopamine on diuresis, renal function, electrolyte balance,
 and 60-day post-discharge outcomes in patients hospitalized with acute decompensated heart
 failure.
Worsening renal function (WRF) and hypokalemia related to diuretic use for acute
 decompensated heart failure (ADHF) are common and portend poor prognosis. Low dose dopamine
 infusion improves renal perfusion. Whether dopamine infusion improves diuresis and/or reduces
 renal complication in ADHF is not known. The aim of this study is to compare the effects of
 high-dose furosemide (HDF, 40 mg furosemide bolus IV, followed by continuous IV infusion of
 20 mg/h for a total of 8 hours) vs. low-dose furosemide combined with low-dose dopamine
 (LDFD, 40 mg furosemide bolus IV, followed by continuous IV infusion of 5 mg/h furosemide
 plus 5μg/kg/min dopamine for a total of 8 hours) on diuresis, renal function, electrolyte
 balance, and 60-day post-discharge outcomes in patients hospitalized with ADHF.
Inclusion Criteria:

 -  patients with New York Heart Association (NYHA) functional class IV heart failure
 according to the American Heart Association (AHA) classification, namely dyspnea on
 minimal exertion or rest dyspnea, orthopnea, and paroxysmal nocturnal dyspnea

 -  signs of congestion (third heart sound or pulmonary rales on physical examination)

 -  pulmonary congestion on chest x-ray

 -  serum B-type natriuretic peptide levels > 400 pg/ml or NT-proBNP > 1500 pg/ml

 -  echocardiographic documentation of systolic or diastolic dysfunction

 -  all candidate patients must be:

 -  Age >18 years old

 -  on medical therapy with an ACE-inhibitor and/or a β-blocker

 -  experiencing an acute decompensation of known chronic HF

 -  Having baseline oxygen saturation <90% on admission arterial blood gas

 Exclusion Criteria:

 -  the investigators will exclude patients with:

 -  acute de novo HF

 -  severe renal failure (serum creatinine > 200 μmol/L or GFR < 30 ml/min/1.73m2)

 -  admission systolic blood pressure < 90 mm Hg

 -  severe valvular disease

 -  known adverse reactions to furosemide or dopamine

 -  HF secondary to congenital heart disease

 -  a scheduled procedure with a need for IV contrast dye

 -  a scheduled cardiac surgery within 6 months