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Renin-Angiotensin-Aldosterone System Optimization for Acute Decompensated Heart Failure Patients (ROAD-HF): Rationale

Bhagwan Dass1,2, Michelle Dimza3, Girish Singhania4

  • 1Division of Hospital Medicine, University of Florida, PO Box 100238, Gainesville, FL, 32610, USA. Bhagwan.Dass@medicine.ufl.edu.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|December 5, 2019
PubMed

Insights

Withholding angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) during acute decompensated heart failure (ADHF) may prevent worsening renal function. This strategy could improve outcomes and reduce healthcare costs for ADHF patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Trials

Background:

  • Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are vital for chronic heart failure but pose risks in acute decompensated heart failure (ADHF).
  • Worsening renal function (WRF) in ADHF patients treated with ACEIs/ARBs is linked to increased mortality.
  • Decreased estimated glomerular filtration rate (eGFR) during ADHF treatment correlates with mortality risk.

Purpose of the Study:

  • To evaluate if temporarily withholding ACEIs/ARBs for 72 hours in ADHF patients prevents WRF.
  • To determine if this withholding strategy allows for more effective diuresis.
  • To assess the impact on acute kidney injury (AKI) rates and overall patient outcomes.

Main Methods:

  • A prospective randomized trial involving 430 ADHF patients.
  • Patients randomized to either withhold ACEIs/ARBs or continue/start them for 72 hours.
  • Primary outcomes: AKI rates, patient global assessment, and change in eGFR; secondary outcomes include weight, fluid balance, congestion, renal function, biomarkers, treatment failure, length of stay, cost, and mortality.

Main Results:

  • This section is to be filled once the trial results are available.
  • The study is designed to provide definitive data on the primary and secondary outcomes.
  • Results will elucidate the impact of ACEI/ARB withdrawal on renal function and clinical outcomes in ADHF.

Conclusions:

  • This clinical trial aims to determine if withholding ACEIs/ARBs prevents AKI in ADHF.
  • Findings will clarify the heart-kidney interactions and optimal ADHF management strategies.
  • Potential benefits include preserved renal function, reduced hospital length of stay, readmissions, and healthcare costs.
Abstract

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