What does this research mean for the field?

In patients with acute heart failure, conventional diuretic therapy reduces elevated levels of atrial natriuretic peptide, arginine vasopressin, and catecholamines, while simultaneously activating the renin-angiotensin system. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the response of circulating vasoactive humoral factors before and during the first week of conventional medical therapy in acute heart failure.

December 1, 1989European Heart Journal

Neuroendocrine response in acute heart failure and the influence of treatment

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Why the study?

Does conventional treatment with intravenous furosemide, oral digoxin, and diuretics alter vasoactive humoral factors in patients with acute heart failure?

Population

27 patients with acute heart failure (16 already on diuretic drugs when admitted to hospital).

Comparison

Conventional treatment consisting of intravenous… vs Baseline.

Design

Cohort

Follow-up

1 week

Authors

MBMats BroqvistLinköping University Hospital UDUlf DahlströmHeart Failure / Cardiomyopathy BKB. E. KarlbergLund University

Discussion

Member takes

Implication

Diuretic-related RAS activation in acute HF warrants monitoring; leaves open net benefit of adjunctive blockade in randomized trials.

Key Points

To evaluate the response of circulating vasoactive humoral factors before and during the first week of conventional medical therapy in acute heart failure.
Assessed 27 patients presenting with acute heart failure, including 16 patients already receiving diuretic therapy prior to hospital admission.
Administered intravenous frusemide upon admission followed by oral maintenance diuretic therapy and digoxin.
Measured serial plasma concentrations of renin activity, angiotensin II, catecholamines, atrial natriuretic peptide, and arginine vasopressin.
Baseline plasma renin activity and angiotensin II were normal in diuretic-naive patients but elevated in pre-treated patients, with subsequent diuretic therapy activating the renin-angiotensin system in all patients.
Elevated catecholamines normalized within one day, while baseline atrial natriuretic peptide (mean 276.9 ± 39.0 pg ml-1) and arginine vasopressin (mean 56.8 ± 14.6 pg ml-1) decreased alongside clinical improvement.

Structured PICO

Does conventional treatment with intravenous furosemide, oral digoxin, and diuretics alter vasoactive humoral factors in patients with acute heart failure?

Population

27 patients with acute heart failure (16 already on diuretic drugs when admitted to hospital).

Intervention

Conventional treatment consisting of intravenous furosemide on admission, followed by oral digoxin and diuretic therapy over the first week.

Comparator

Baseline (measurements taken before drug treatment).

Outcome

Changes in vasoactive humoral factors (plasma renin activity, plasma angiotensin II, catecholamines, atrial natriuretic peptide, and arginine vasopressin) during the first week of treatment.surrogate

Conventional treatment of acute heart failure with diuretics and digoxin reduces elevated catecholamines, ANP, and AVP, but activates the renin-angiotensin system.

Cite This Study

Broqvist et al. (1989) studied this question.

synapsesocial.com/papers/6a1a20cd8db9fef88db4f50c https://doi.org/10.1093/oxfordjournals.eurheartj.a059429

Topics

Heart failure HFrEF treatment Heart failure hospitalization

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Neuroendocrine response in acute heart failure and the influence of treatment

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Neuroendocrine response in acute heart failure and the influence of treatment

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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