Heart failure & cardiomyopathies
Prevalence and Characteristics of Upfront Diuretic Resistance in Acute Heart Failure: The P-Value-AHF Study
Authors' conclusion
Upfront diuretic resistance in an unselected population of AHF patients presenting to the ED affects only a minority of patients.
Study context
- Population
- Consecutive patients presenting to the emergency department (ED) with acute heart failure (AHF), ≥1 sign of congestion and NT-proBNP >1000 ng/L, February–June 202493 per-protocol-treated
- Participants
- 127 patients
- Primary endpoint
- Prevalence of upfront diuretic resistance (urine volume <300 mL in 2 h and urine sodium <70 mmol/L after first i.v. loop diuretic)
- Follow-up
- 2 h
Methodological detailsprospective, per-protocol, Loop diuretic per protocol: furosemide 40 mg i.v. (diuretic-naïve or oral torasemide <40 mg) or 80 mg i.v. (oral torasemide ≥40 mg daily)
- Prospective
- Per-protocol
- Loop diuretic per protocol: furosemide 40 mg i.v. (diuretic-naïve or oral torasemide <40 mg) or 80 mg i.v. (oral torasemide ≥40 mg daily)
Primary result
As reported in the abstract
Upfront diuretic resistance
Patients meeting criteria of upfront diuretic resistance (2 of 93)
2.2%
Adequate diuretic response (urine volume or urine sodium)
91 of 93
Further findings
Characteristics of patients with vs without diuretic resistance (post-hoc)
- Diuretic resistance: higher prevalence of chronic kidney or liver disease, markedly lower BP and heart rate, markedly higher serum creatinine and potassium, lower serum sodium
- Clinical signs of congestion, NT-proBNP and LVEF similar in both groups
- Post-hoc analysis
Original publication
Prevalence and Characteristics of Upfront Diuretic Resistance in Acute Heart Failure: The P-Value-AHF Study. ESC Heart Fail. Published 6 September 2024. doi:10.
Summarised from the published abstract; every number is checked against it