Let’s wait for the chest x-ray they said….let’s try them on BiPAP first they said.   But were they correct?

REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in the Emergency Department of Acute Heart Failure) was recently published in the Journal of the American College of Cardiology.  It is a prospective, multicenter, observation cohort study that looked at the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the ED.


D2F (door to furosemide): time from entering the ED to first IV lasix dose

Early treatment group: D2F < 60 minutes

Primary endpoint: all cause in hospital mortality

The study included 1291 AHF patients with 481 in the early treatment group.  These patients were more likely to arrive by ambulance and had more clinical signs of congestion compared to the nonearly treatment group (so technically these were sicker patients).  The earlier treatment remained significantly associated with lower in-hospital mortality.  Mortality steeply increased as D2F time was delayed (not linear), but leveled off after 100 minutes.

Conclusion: give lasix to your AHF patients and give it early because TIME IS LIFE.  And remember 80 is the new 40.


Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol 2017;69:3042-3051