Natriuresis-guided diuretic therapy for 36 hours had no significant effect on decongestion assessed by ultrasound and biomarkers compared to standard of care in patients with acute heart failure.
RCT (n=51)
Randomized
Does natriuresis-guided diuretic therapy improve decongestion assessed by ultrasound, biomarkers, and clinical evaluation in patients with acute heart failure compared to standard of care?
Natriuresis-guided diuretic therapy for the first 36 hours in acute heart failure does not significantly improve decongestion markers compared to standard of care, despite overall improvements during hospitalization.
Abstract Background Natriuresis-guided therapy has emerged as a potential strategy to optimize decongestion in acute heart failure (AHF), as it significantly improves diuresis and natriuresis up to 48 hours, yet its impact on congestion markers remains unclear. Therefore, we investigated the effect of natriuresis-guided therapy on decongestion, using an assessment of congestion that included ultrasound, biomarkers, and clinical evaluation, compared to standard of care. Methods To evaluate the effect of natriuresis-guided therapy on decongestion, clinical congestion score (CCS) and congestion biomarkers were assessed in the PUSH-AHF study. In the intervention arm, decongestive therapy was adjusted based on natriuresis and diuresis for the first 36 hours of decongestive therapy. The OPTICS-AHF substudy evaluated 51 patients using renal, lung, and cardiac ultrasounds alongside comprehensive clinical evaluations at baseline, day 2, day 3, and discharge. Results Patients with more congestion at baseline were older, had higher left ventricular ejection fraction and a lower baseline hemoglobin (all P0.05). Higher baseline CCS was associated with increased diuresis at all time points (all P0.05), regardless of treatment allocation. Congestion biomarkers decreased significantly from baseline to discharge, irrespective of randomization arm (P³0.20). Across all time points, bio-ADM correlated more with diuresis, while NT-proBNP correlated more with natriuresis. Decongestion during hospitalization was associated with significant improvements in renal and pulmonary ultrasound parameters of congestion, independent of randomization group (P0.60). Conclusions While decongestive therapy during hospitalization significantly improved congestion markers, including biomarkers and bedside ultrasound parameters, no significant effect of 36 hours of natriuresis-guided therapy on decongestion was observed.Graphical abstract
Beldhuis et al. (Sat,) conducted a rct in Acute heart failure (n=51). Natriuresis-guided diuretic therapy vs. Standard of care was evaluated on Decongestion (assessed by clinical congestion score, biomarkers, and ultrasound parameters). Natriuresis-guided diuretic therapy for 36 hours had no significant effect on decongestion assessed by ultrasound and biomarkers compared to standard of care in patients with acute heart failure.