Document Type : Original Article


1 Emergency Department, Tabriz University of Medical Sciences, Tabriz, Iran

2 Pharmacology and Toxicology Department, Tabriz University of Medical Sciences, Tabriz, Iran


Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED) without admission with patients who were admitted to hospital for standard treatment.
Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0.
Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00).
Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00).


Main Subjects

1. Ni H. Prevalence of self-reported heart failure among US adults: results from the 1999 National Health Interview Survey. Am Heart J 2003; 146(1): 121-8.
2. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003; 289(2): 194-202.
3. Jason W, Paul J. Diagnosis and management of heart failure in the outpatient setting. Prim Care Clin Office Pract 2005; 32(4): 1115-29.
4. Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur
Heart J 2005; 26(4): 384-416.
5. Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 2005; 149(2): 209-16.
6. Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, et al. International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation 2005; 112(25): 3958-68.
7. American Heart Association. Heart disease and stroke statistics 2005 update. Dallas (TX): American Heart Association; 2005. Available at: Accessed April 3, 2005.
8. Peacock WF 4th, Remer EE, Aponte J, Moffa DA, Emerman CE, Albert NM. Effective observation unit treatment of decompensated heart failure. Congest Heart Fail 2002; 8(2): 68-73.
9. Peacock WF, Albert NM. Observation unit management of heart failure. Emerg Med Clin North Am 2001; 19(1): 209-32.
10. Peacock WF, Remer EE, Aponte J, Moffa DA, Emerman CE, Albert NM. Management of acute decompensated heart failure in the emergency department. Congest Heart Fail 2003; 9 (5 suppl 1): 3-18.
11. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (committee to revise the 1995 guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001; 38(7): 2101–13.
12. Brater DC. Diuretic therapy. N Engl J Med 1998; 339(6): 387–95.
13. Kramer BK, Schweda F, Riegger GA. Diuretic treatment and diuretic resistance in heart failure. Am J Med 1999; 106(1): 90–6.
14. Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, et al. Randomised trial of highdose isosorbide dinitrate plus low-dose furosemide versus highdose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 1998; 351(9100): 389-393.
15. Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS; American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Ann Emerg Med 2007; 49(5): 627-69
16. Peacock WF 4th, Young J, Collins S, Diercks D, Emerman C. Heart failure observation units: optimizing care. Ann Emerg Med 2006; 47(1): 22-33.