Adaptation and applicability of a diuretic algorithm for patients with heart failure

Congestive states can be identified and managed through algorithms such as the Diuretic Treatment Algorithm (DTA) to adjust the diuretic over the telephone, focused on the clinical evaluation. However, the DTA is currently available only in English.

To adapt the DTA and test its applicability for Brazil in outpatients with heart failure.

The stages of translation, synthesis, back-translation, review by an expert committee, and pre-test (clinical applicability by means of a random clinical trial) were followed. The Brazilian version of the DTA was called algoritmo de ajuste de diurético (AAD; as per its acronym in Portuguese, standing for diuretic adjustment algorithm). Patients were randomized to the intervention group (IG) - diuretic adjustment according to the AAD - or control group (CG) - conventional adjustment. The clinical congestion score (CCS) and weight values were obtained for both groups.

A total of 12 changes were made to the DTA. Thirty-four patients were included. For those with congestion, the increase in the diuretic as guided by the AAD solved their condition, reducing the CCS by two points for 50% of the sample -2 (-3.5; -1.0), while the median for the CG was 0 (-1.25; -1.0), (p < 0.001). The median for weight variation was greater in IG -1.4 (-1.7; -0.5) compared to the CG 0.1 (1.2; -0.6), p = 0.001.

The AAD proved applicable in clinical practice after adaption and appears to result in better congestion management in patients with heart failure. The clinical effectiveness of the tool should be tested in a larger patient sample aiming at validating the instrument for Brazil.