Diuresis Efficacy in Ambulatory Congested Heart Failure Patients: Intrapatient Comparison of 3 Diuretic Regimens (DEA-HF).
JACC Heart Fail
; 12(8): 1396-1405, 2024 Aug.
Article
in En
| MEDLINE
| ID: mdl-38739124
ABSTRACT
BACKGROUND:
Limited evidence exists regarding efficacy and safety of diuretic regimens in ambulatory, congestion-refractory, chronic heart failure (CHF) patients.OBJECTIVES:
The authors sought to compare the potency and safety of commonly used diuretic regimens in CHF patients.METHODS:
A prospective, randomized, open-label, crossover study conducted in NYHA functional class II to IV CHF patients, treated in an ambulatory day-care unit. Each patient received 3 different diuretic regimens intravenous (IV) furosemide 250 mg; IV furosemide 250 mg plus oral metolazone 5 mg; and IV furosemide 250 mg plus IV acetazolamide 500 mg. Treatments were administered once a week, in 1 of 6 randomized sequences. The primary endpoint was total sodium excretion, and the secondary was total urinary volume excreted, both measured for 6 hours post-treatment initiation.RESULTS:
A total of 42 patients were recruited. Administration of furosemide plus metolazone resulted in the highest weight of sodium excreted, 4,691 mg (95% CI 4,153-5,229 mg) compared with furosemide alone, 3,835 mg (95% CI 3,279-4,392 mg; P = 0.015) and to furosemide plus acetazolamide 3,584 mg (95% CI 3,020-4,148 mg; P = 0.001). Furosemide plus metolazone resulted in 1.84 L of urine (95% CI 1.63-2.05 L), compared with 1.58 L (95% CI 1.37-1.8); P = 0.039 collected following administration of furosemide plus acetazolamide and 1.71 L (95% CI 1.49-1.93 L) following furosemide alone. The incidence of worsening renal function was significantly higher when adding metolazone (39%) to furosemide compared with furosemide alone (16%) and to furosemide plus acetazolamide (2.6%) (P < 0.001).CONCLUSIONS:
In ambulatory CHF patients, furosemide plus metolazone resulted in a significantly higher natriuresis compared with IV furosemide alone or furosemide plus acetazolamide.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cross-Over Studies
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Diuretics
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Furosemide
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Heart Failure
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Metolazone
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Acetazolamide
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
JACC Heart Fail
Year:
2024
Document type:
Article
Affiliation country:
Israel
Country of publication:
United States