Study objective: To determine the efficacy, safety, and
economic benefit of continuous IV infusion of furosemide as a treatment
modality for elderly patients with class IV heart failure.
Design: Prospective trial of consecutively admitted elderly
patients > 65 years old with class IV heart failure.
Setting: A single cardiovascular service in a university
Patients: Seventeen male and female
patients > 65 years old consecutively admitted to a cardiovascular
Results: High-dose, continuous IV infusion of
furosemide was successful in providing a 9- to 20-L diuresis in an
average of 3.5 days without causing clinical complications or
aberrations in blood chemistry. The length of stay was 2.3 days shorter
than a contemporary group of class III and class IV elderly
patients with heart failure managed on other medical services. The
Medicare reimbursement for heart failure was $6,047. Patients receiving
IV bolus diuretic therapy incurred billing charges of $10,193, or a
loss of $4,146 per patient to the hospital. Patients receiving diuretic
infusion therapy incurred billing charges of $4,944. This was a
difference of $5,249 per patient treated by continuous IV infusion
compared to bolus therapy and a profit per Medicare patient of $1,103.
Therefore, a $4,146 billing loss was converted to $1,103 profit.
Conclusion: IV furosemide infusion therapy for class IV
heart failure in the elderly is a safe, effective, and economic mode of