The effects of a sliding scale diuretic titration protocol in patients with heart failure

Marilyn A. Prasun, Abraham G. Kocheril, Patricia H. Klass, Stephanie H. Dunlap, Mariann R. Piano

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Patients with heart failure (HF) are often instructed to temporarily adjust their diuretic dose. This approach has become routine in some HF management programs; however, no study has specifically examined the effects of a patient-directed flexible diuretic protocol. For the purposes of this study, patients were randomized into a usual care (UC) group (n = 31) or a flexible diuretic titration (DT) group (n = 35). The DT group completed a 6-item diuretic titration protocol once a day, for 3 months. The 6-minute walk distance, plasma B-type natriuretic peptide (NT-BNP), plasma norepinephrine (NE), and quality of life (QOL) were measured at baseline and at 3 months. Hospitalizations, emergency department (ED) visits, and mortality rates were measured at 3 months. Compared to baseline, at 3 months, there was a significant increase in the DT group's 6-minute walk distance (646 60 ft vs 761 61 ft, P =.01) and total QOL score (53 5 vs 38 5, P =.001), whereas these parameters remained unchanged within the UC group. There were significantly less ED visits in the DT group compared with those in the UC group (3% vs 23%, P =.015). No differences were found between the groups in HF-related hospitalizations or mortality. Within both groups, no differences were found between baseline and 3-month NE or NT-BNP plasma values. Patients with heart failure who used a sliding scale diuretic titration protocol had significant improvements in their exercise tolerance and QOL, had fewer ED visits, and had no change in plasma NE or NT-BNP levels.

Original languageEnglish (US)
Pages (from-to)62-70
Number of pages9
JournalJournal of Cardiovascular Nursing
Issue number1
StatePublished - Jan 1 2005
Externally publishedYes


  • B-type natriuretic peptide
  • Diuretic titration
  • Diuretics
  • Exercise tolerance
  • Norepinephrine
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


Dive into the research topics of 'The effects of a sliding scale diuretic titration protocol in patients with heart failure'. Together they form a unique fingerprint.

Cite this