Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Clinical Question
Can the addition of acetazolamide to intravenous diuretics lead to faster decongestion in hospitalized patients with acute decompensated heart failure?
Bottom line
For patients with chronic heart failure who are hospitalized with acute volume overload, the addition of acetazolamide to intravenous loop diuretics leads to faster decongestion. You would need to treat 9 patients with acetazolamide to have one additional patient achieve this outcome. Of note, this trial was initiated prior to the use of SGLT-2 inhibitors for the treatment of heart failure and had a population that was predominantly white. The results may not be generalizable to all populations. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Inpatient (any location)
Synopsis
These investigators randomized hospitalized adults with acute decompensated heart failure (one clinical sign of volume overload plus elevated NT-pro-BNP or BNP) to receive intravenous acetazolamide 500 mg daily (n = 259) or matching placebo (n = 260) for 3 days. All patients also received standardized intravenous loop diuretic therapy at double the dose of their oral maintenance therapy. Those taking maintenance acetazolamide or sodium-glucose cotransporter 2 (SLGT-2) inhibitors were excluded. Trial participants had a mean age of 78 years, two-thirds were men, and 99% were white. Additionally, 87% were classified as New York Heart Association class III or IV. The primary outcome was successful decongestion, defined as the absence of signs of volume overload within 3 days of randomization without a need for escalation of decongestive therapy. Overall, more patients in the acetazolamide group than in the placebo group achieved the primary outcome (42.2% vs 30.5%; relative risk [RR] 1.46; 95% CI 1.17 - 1.82). This was consistent across all subgroups, except for a smaller benefit seen in patients receiving a higher dose of maintenance diuretics compared with those receiving a lower dose. Further, the acetazolamide group had a shorter hospital stay (8.8 vs 9.9 days; RR 0.89; 0.81 - 0.98) and a higher incidence of successful decongestion at discharge (62.5% vs 78.8%; RR 1.27; 1.13 - 1.43). Adverse events were similar in the 2 groups and there were no differences detected in death or rehospitalization at 3 months.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Acetazolamide
Good information in the battle against CHF
Insuffisance cardiaque
Article pertinent dans le contexte de l’hospitalisation pour l’insuffisance cardiaque aiguë et pour une période de temps courte
acetazolamide in acute chf
good addition to iv diuretics