Key result
IV acetazolamide reduces residual congestion in acute HF, but congestion remains linked to mortality and HFH.
Why the study?
To evaluate factors influencing decongestion success and the impact of acetazolamide on 3-month clinical outcomes in patients with acute heart failure.
Does intravenous acetazolamide reduce residual congestion and improve 3-month clinical outcomes (mortality or heart failure hospitalization) in patients with acute heart failure?
RCT (n=519)
Placebo-controlled
Randomized
Does intravenous acetazolamide reduce residual congestion and improve 3-month clinical outcomes (mortality or heart failure hospitalization) in patients with acute heart failure?
Answers are grounded in this paper and cite their sources.
In acute heart failure, upfront acetazolamide reduces residual congestion, but patients who remain congested despite treatment face a high risk of mortality and rehospitalization.
AIMS: Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, improves decongestion in acute heart failure (AHF). The aim of the current subanalysis is to evaluate which factors influence decongestion success and the impact of acetazolamide on 3-month clinical outcomes. METHODS: This analysis of the Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) trial, that randomised 519 patients with AHF to intravenous acetazolamide or matching placebo, assessed the relationship between acetazolamide treatment, residual congestion, and all-cause mortality and/or heart failure hospitalisation (HFH). CONCLUSIONS: Residual congestion after decongestive treatment for AHF is associated with an increased risk of all-cause mortality and HFH. The upfront addition of acetazolamide reduced the incidence of residual congestion. However, patients with residual congestion despite acetazolamide use are at excessive risk for mortality and HFH, identifying a subset of patients requiring specialised heart failure care.
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Meekers et al. (2026) conducted an RCT in Acute heart failure (n=519). Intravenous acetazolamide vs. Matching placebo was evaluated on All-cause mortality and/or heart failure hospitalisation (HFH) (p=0.019). Intravenous acetazolamide reduced the incidence of residual congestion in acute heart failure, though residual congestion remained associated with increased mortality and HFH (P=0.019).
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