Heart failure & cardiomyopathiesMeta-analysis
Contemporary decongestion strategies in acute heart failure: an individual patient data analysis of three randomized controlled trials
- Individual patient data meta-analysis of randomised controlled trials
- pooled analysis of 3 randomized controlled trials (RCTs) (ADVOR, CLOROTIC, PUSH-AHF)
Authors' conclusion
While intensified decongestive strategies in patients hospitalized for ADHF improve diuresis, natriuresis, and reduce LOS, no benefit was observed for post-discharge clinical outcomes.
Study context
- Population
- Patients hospitalised for acute decompensated heart failure (HF)
- Participants
- 1,059 patients · 3 RCTs
- Comparison
- Intensified decongestive treatment vs control
- Outcome
- HF re-hospitalisation and/or all-cause mortality (adjusted for sex and trial)
- Follow-up
- 90 days
Pooled result
As reported in the abstract
Adjusted hazard ratio
1.03
95% CI 0.81–1.30
Intensified treatment vs Placebo
adjusted HR 1.03 (95% CI 0.81–1.30)
Further pooled results
| Outcome | adjusted OR (95% CI) | P value | |
|---|---|---|---|
| In-hospital mortality · exploratory and hypothesis-generating | 0.55 (0.31–0.96) | P = 0.038 | |
| 0.20.5125Adjusted odds ratio (log scale) |
Length of stay
- Length of stay — Significantly shorter with intensified treatment
- adjusted P = .002
Cumulative diuresis and natriuresis · 24 and 48 h
- Significantly higher with intensified treatment
- adjusted P < .001
Safety
Doubling of serum creatinine · 3 days
- No difference between groups
- adjusted P = .123
Original publication
Contemporary decongestion strategies in acute heart failure: an individual patient data analysis of three randomized controlled trials. Eur J Heart Fail. Published 2 September 2026. doi:10.1093/ejhf/xuag253
Summarised from the published abstract; every number is checked against it