Diuresis Efficacy in Ambulatory Congested Heart Failure Patients

doi:10.1016/j.jchf.2024.04.014

Heart failure & cardiomyopathiesRandomised controlled trial

Diuresis Efficacy in Ambulatory Congested Heart Failure Patients

JACC Heart FailPublished 11 May 2024

Randomised crossover trial
prospective
open-label
6 randomised sequences

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Authors' conclusion

In ambulatory CHF patients, furosemide plus metolazone resulted in a significantly higher natriuresis compared with IV furosemide alone or furosemide plus acetazolamide.

Study context

Population: Ambulatory NYHA class II–intravenous (IV) chronic HF patients treated in a day-care unitcrossover
Participants: 42 patients

Comparison: IV furosemide alone vs furosemide plus metolazone vs furosemide plus acetazolamide
Primary endpoint: Total sodium excretion
Follow-up: 6 hours post-treatment initiation

Primary result

As reported in the abstract

Sodium excreted · 6 hours

Furosemide plus metolazone4,69195% CI 4,153–5,229 · mg

Furosemide3,83595% CI 3,279–4,392 · mg

Furosemide plus acetazolamide3,58495% CI 3,020–4,148 · mg

Furosemide plus metolazone vs Furosemide: P = 0.015 · Furosemide plus metolazone vs Furosemide plus acetazolamide: P = 0.001

Further findings

Total urinary volume · 6 hours

P = 0.039

Furosemide1.71 L95% CI 1.49–1.93

Furosemide plus metolazone1.84 L95% CI 1.63–2.05

Furosemide plus acetazolamide1.58 L95% CI 1.37–1.8

Safety

Worsening renal function

Furosemide16%

Furosemide plus metolazone39%

Furosemide plus acetazolamide2.6%

Worsening renal function: P < 0.001

Original publication

Diuresis Efficacy in Ambulatory Congested Heart Failure Patients. JACC Heart Fail. Published 11 May 2024. doi:10.1016/j.jchf.2024.04.014

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Summarised from the published abstract; every number is checked against it