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Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
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[Congestive heart failure: Treatment with ultrafiltration]
C Taron-Brocard1, V Looten1, B Fahlgren1
1Comité d'évaluation et de diffusion des innovations technologiques (CEDIT), AP-HP, 3, avenue Victoria, 75004 Paris, France.
Annales De Cardiologie Et D'Angeiologie
|June 27, 2016
Summary
Ultrafiltration therapy shows benefits in fluid removal and weight reduction for congestive heart failure patients. However, its impact on mortality, safety, and cost-effectiveness requires further large-scale evaluation.
Area of Science:
- Cardiology
- Nephrology
- Health Technology Assessment
Background:
- Congestive heart failure affects approximately 2% of the population in high-income countries.
- Intravenous diuretics are a common treatment for fluid overload in heart failure.
Purpose of the Study:
- To assess the overall benefits and effectiveness of ultrafiltration therapy in patients with acute or persistent congestive heart failure.
- To evaluate ultrafiltration therapy compared to standard diuretic treatment.
Main Methods:
- A health technology assessment was performed following EUnetHTA guidelines.
- Systematic literature review of medical databases, expert interviews, and manufacturer interviews were conducted.
- Analysis included thirteen clinical trials and five meta-analyses.
Main Results:
- Ultrafiltration therapy demonstrated significant benefits in fluid removal (1.28L) and body weight reduction (1.44kg) compared to intravenous loop diuretics.
- No significant differences were observed in overall mortality, renal function, hospital readmission rates, or safety profiles.
- Medico-economic studies yielded incomplete and contradictory findings.
Conclusions:
- Ultrafiltration therapy appears effective, particularly for patients resistant or ineligible to intravenous diuretics.
- Uncertainties remain regarding its impact on overall mortality, safety, and cost-effectiveness.
- Cautious generalization of ultrafiltration therapy is recommended pending large-scale systematic evaluation.
Keywords:
AquapheresisAquaphérèseCongestive heart failureHemofiltrationHémofiltrationInsuffisance cardiaque congestiveRenal replacement therapyUltrafiltrationÉpuration extra-rénaleMore Related Videos
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