TABLE 1.

Stepped Diuretic Algorithm Used in the CARRESS-HF and AVOID-HF Trials (56,62)

	Current Diuretic Regimen		Suggested Diuretic Regimen
Step	Furosemide Dose	Thiazide	Furosemide Dose (IV)	Metolazone
1	≤80 mg/day	+/−	40 mg + 5 mg/h	0
2	81–160 mg/day	+/−	80 mg + 10 mg/h	5 mg QD
3	161–240 mg/day	+/−	80 mg + 20 mg/h	5 mg BID
4*	>240 mg/day	+/−	80 mg + 30 mg/h	5 mg BID

The starting diuretic dose is determined by the outpatient or current inpatient diuretic dose, and the patient is moved to a higher diuretic dose if urine output is <3 l/day on the current dose. All loop diuretic doses are given in furosemide equivalents, although an alternative loop diuretic could be used. *A vasodilator or inotrope can be added for patients who have urine output <3 l/day despite Step 4 diuretic dosing.

AVOID-HF = Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure; BID = twice daily; CARRESS-HF = Cardiorenal Rescue Study in Acute Decompensated Heart Failure; IV = intravenous; QD = every day.