The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department
Authors: Miró Òscar , Harjola Pia , Rossello Xavier , Gil Víctor , Jacob Javier , Llorens Pere , Martín-Sánchez Francisco Javier , Herrero Pablo , Martínez-Nadal Gemma , Aguiló Sira , López-Grima María Luisa , Fuentes Marta , Álvarez Pérez José María , Rodríguez-Adrada Esther , Mir María , Tost Josep , Llauger Lluís , Ruschitzka Frank , Harjola Veli-Pekka , Mullens Wilfried , Masip Josep , Chioncel Ovidiu , Peacock W Frank , Müller Christian , Mebazaa Alexandre ,   the ICA-SEMES Research Group, Fuentes Marta , Gil Cristina , Alonso Héctor , Pérez-Llantada Enrique , Martín-Sánchez Francisco Javier , García Guillermo Llopis , Cadenas Mar Suárez , Miró Òscar , Gil Víctor , Escoda Rosa , Aguiló Sira , Sánchez Carolina , Pérez-Durá María José , Salvo Eva , Pavón José , Noval Antonio , Torres José Manuel , López-Grima María Luisa , Valero Amparo , Juan María Ángeles , Aguirre Alfons , Pedragosa Maria Angels , Masó Silvia Mínguez , Alonso María Isabel , Ruiz Francisco , Franco José Miguel , Mecina Ana Belén , Tost Josep , Berenguer Marta , Donea Ruxandra , Ramón Susana Sánchez , Rodríguez Virginia Carbajosa , Piñera Pascual , Nicolás José Andrés Sánchez , Garate Raquel Torres , Alquézar-Arbé Aitor , Rizzi Miguel Alberto , Herrera Sergio , Jacob Javier , Roset Alex , Cabello Irene , Haro Antonio , Richard Fernando , Pérez José María Álvarez , Diez María Pilar López , Puente Pablo Herrero , Álvarez Joaquín Vázquez , García Belén Prieto , García María García , González Marta Sánchez , Llorens Pere , Javaloyes Patricia , Marquina Víctor , Jiménez Inmaculada , Hernández Néstor , Brouzet Benjamín , Espinosa Begoña , Gil Adriana , Andueza Juan Antonio , Romero Rodolfo , Ruíz Martín , Calvache Roberto , Serralta María Teresa Lorca , Jave Luis Ernesto Calderón , Arriaga Beatriz Amores , Bergua Beatriz Sierra , Mojarro Enrique Martín , Jiménez Brigitte Silvana Alarcón , Bécquer Lisette Travería , Burillo Guillermo , García Lluís Llauger , LaSalle Gerard Corominas , Urbano Carmen Agüera , Soto Ana Belén García , Padial Elisa Delgado , Ferrer Ester Soy , Múñoz María Adrover , Garrido José Manuel , Lucas-Imbernón Francisco Javier , Gaya Rut , Bibiano Carlos , Mir María , Rodríguez Beatriz , Carballo José Luis , Rodríguez-Adrada Esther , Miranda Belén Rodríguez , Martín Monika Vicente , Casanova Pere Coma , Alvarós Joan Espinach 
Published: January 2021

Abstract

Aims
The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED.

Methods and results
In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (&gt;10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085–1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146–1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995–1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817–1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845–1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915–1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings.

Conclusion
Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.