Heart failure & cardiomyopathiesSecondary analysis
Diuretic Resistance Risk and the Efficacy of Natriuresis-Guided Diuretic Therapy in Acute Heart Failure
- Secondary analysis of the PUSH-AHF randomised trial
- post hoc analysis
- subgroup analysis by BAN-ADHF score
Authors' conclusion
Patients with a high BAN-ADHF score had impaired natriuresis and worse clinical outcomes. Natriuresis-guided therapy improved 24-hour natriuresis consistently across the spectrum of BAN-ADHF scores, with enhanced natriuretic effects at later time points among those with high DR risk.
Study context
- Population
- Patients with acute decompensated HF in the PUSH-AHF trial21% high BAN-ADHF score
- Participants
- 306 patients
- Comparison
- Low diuretic resistance (DR) risk vs High DR risk
- Primary endpoint
- Dual primary endpoint: 24-hour natriuresis and time to all-cause mortality or HF rehospitalization
- Follow-up
- 180 days
Primary result
As reported in the abstract
Natriuresis-guided therapy increased 24-hour natriuresis regardless of baseline DR risk
P interaction = 0.364
BAN-ADHF score did not modify the treatment effect on the overall neutral composite clinical outcome
P interaction = 0.391
Secondary outcomes
24-h and 48-h natriuresis and composite endpoint (all-cause mortality or HF rehospitalization), high vs low BAN-ADHF score
- 24-h natriuresis, high vs low BAN-ADHF score
- 294 vs 398 mmol; P < 0.001
- 48-h natriuresis, high vs low BAN-ADHF score
- 514 vs 641 mmol; P = 0.001
- Composite endpoint, high BAN-ADHF score, HR
- 3.51 (2.33-5.30); P < 0.001 (95% CI)
Effect of natriuresis-guided therapy on 48-h and 72-h natriuresis, by BAN-ADHF score
- 48-h natriuresis: BAN-ADHF score modified treatment effect
- P for interaction = 0.038
- 72-h natriuresis: BAN-ADHF score modified treatment effect
- P for interaction = 0.068
- Increased natriuresis with natriuresis-guided therapy in high BAN-ADHF score
Original publication
Summarised from the published abstract; every number is checked against it