What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute decompensated heart failure (ADHF) (n=801). Intervention: Ultrafiltration vs. Usual care (diuretic therapy). Primary outcome: Fluid removal (Difference in means 1372.5 mL, 95% CI 849.6 to 1895.4, p=<0.001).

November 26, 2020Heart Failure ReviewsOpen Access

Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis

Q: What are the key findings of this study?

Ultrafiltration significantly increased fluid removal (difference in means 1372.5 mL) and reduced heart failure rehospitalization (OR 0.54) compared to diuretic therapy in acute heart failure.

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Key result

Ultrafiltration cuts rehospitalization ~46% versus diuretics in acute heart failure alongside greater fluid removal.

Difference in means 1372.5 mL
95% CI 849.6 to 1895.4
P<0.001
n=801

Why the study?

Studies on the effectiveness of ultrafiltration in patients hospitalized with acute decompensated heart failure have led to heterogeneous study outcomes.

Does ultrafiltration improve fluid removal and reduce rehospitalization compared to usual diuretic therapy in patients with acute decompensated heart failure?

Population

801 participants across 8 randomized controlled trials with ADHF

Comparison

Ultrafiltration vs usual diuretic therapy

Design

Meta-analysis of randomized controlled trials

Authors

BWBastian WobbeKlinikum Oldenburg JWJuliane WagnerUniversity Hospital Schleswig-Holstein DSDorottya SzabóUniversity of Pecs

Discussion

Member takes

Implication

Ultrafiltration improves decongestion and reduces rehospitalization versus diuretics in acute HF; reinforces RCT evidence for its use in volume overload.

Study Design

Type

Meta-Analysis (n=801)

Structured PICO

Does ultrafiltration improve fluid removal and reduce rehospitalization compared to usual diuretic therapy in patients with acute decompensated heart failure?

Population

801 adults diagnosed with acute decompensated heart failure (ADHF) presenting with signs and symptoms of congestion, pooled from 8 randomized controlled trials.

Intervention

Ultrafiltration (UF) at a rate of 100 to 500 mL/h using devices such as Aquadex System 100, NxStage System One, or PRISMA System.

Comparator

Usual care treatment using diuretic agents (loop diuretics, e.g., furosemide up to 1446 mg/day).

Outcome

Amount of fluid removal (mL), number of patients rehospitalized for heart failure during follow-up, and incidences of adverse events (worsening heart failure and renal impairment).

Main Result

Effect estimate: Difference in means 1372.5 mL (95% CI 849.6 to 1895.4)

p-value: p=<0.001

Ultrafiltration is a safe and effective alternative to diuretic therapy in volume-overloaded acute heart failure, significantly increasing fluid removal and reducing heart failure rehospitalizations without worsening renal function.

Limitations

Considerable differences in the intervention protocols (UF rate, diuretic dosage, etc.) and time of measurement across the included studies
Possible risks of bias within the studies, particularly industry funding
Evidence of heterogeneity for certain outcomes, which might be explained by the small number of studies
Different search terms were used to identify suitable studies during the selection process
Small number of studies
Differences in intervention protocols (UF rate, diuretic dosage) and time of measurement across the included studies
Possible risks of bias within the studies (funding)
Evidence of heterogeneity for certain outcomes
Different search terms were used individually adapted to the databases

Cite This Study

Wobbe et al. (2020) conducted a meta-analysis in Acute decompensated heart failure (ADHF) (n=801). Ultrafiltration vs. Usual care (diuretic therapy) was evaluated on Fluid removal (Difference in means 1372.5 mL, 95% CI 849.6 to 1895.4, p=<0.001). Ultrafiltration significantly increased fluid removal (difference in means 1372.5 mL) and reduced heart failure rehospitalization (OR 0.54) compared to diuretic therapy in acute heart failure.

synapsesocial.com/papers/6a082498df3db87398107de7 https://doi.org/10.1007/s10741-020-10057-7

Topics

Heart failure hospitalization HFrEF treatment Heart failure

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November 26, 2020Heart Failure ReviewsOpen Access

Ultrafiltration is better than diuretic therapy for volume-overloaded acute heart failure patients: a meta-analysis

View Full Paper

Ask AI

Bookmark

Key result

Ultrafiltration cuts rehospitalization ~46% versus diuretics in acute heart failure alongside greater fluid removal.

Difference in means 1372.5 mL
95% CI 849.6 to 1895.4
P<0.001
n=801

Why the study?

Studies on the effectiveness of ultrafiltration in patients hospitalized with acute decompensated heart failure have led to heterogeneous study outcomes.

Does ultrafiltration improve fluid removal and reduce rehospitalization compared to usual diuretic therapy in patients with acute decompensated heart failure?

Population

801 participants across 8 randomized controlled trials with ADHF

Comparison

Ultrafiltration vs usual diuretic therapy

Design

Meta-analysis of randomized controlled trials

Authors

BWBastian WobbeKlinikum Oldenburg JWJuliane WagnerUniversity Hospital Schleswig-Holstein DSDorottya SzabóUniversity of Pecs

Discussion

Member takes

Implication

Ultrafiltration improves decongestion and reduces rehospitalization versus diuretics in acute HF; reinforces RCT evidence for its use in volume overload.

Study Design

Type

Meta-Analysis (n=801)

Structured PICO

Does ultrafiltration improve fluid removal and reduce rehospitalization compared to usual diuretic therapy in patients with acute decompensated heart failure?

Population

801 adults diagnosed with acute decompensated heart failure (ADHF) presenting with signs and symptoms of congestion, pooled from 8 randomized controlled trials.

Intervention

Ultrafiltration (UF) at a rate of 100 to 500 mL/h using devices such as Aquadex System 100, NxStage System One, or PRISMA System.

Comparator

Usual care treatment using diuretic agents (loop diuretics, e.g., furosemide up to 1446 mg/day).

Outcome

Amount of fluid removal (mL), number of patients rehospitalized for heart failure during follow-up, and incidences of adverse events (worsening heart failure and renal impairment).

Main Result

Effect estimate: Difference in means 1372.5 mL (95% CI 849.6 to 1895.4)

p-value: p=<0.001

Limitations

Considerable differences in the intervention protocols (UF rate, diuretic dosage, etc.) and time of measurement across the included studies
Possible risks of bias within the studies, particularly industry funding
Evidence of heterogeneity for certain outcomes, which might be explained by the small number of studies
Different search terms were used to identify suitable studies during the selection process
Small number of studies
Differences in intervention protocols (UF rate, diuretic dosage) and time of measurement across the included studies
Possible risks of bias within the studies (funding)
Evidence of heterogeneity for certain outcomes
Different search terms were used individually adapted to the databases

Cite This Study

synapsesocial.com/papers/6a082498df3db87398107de7 https://doi.org/10.1007/s10741-020-10057-7

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

Heart failure hospitalization HFrEF treatment Heart failure

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