Acetazolamide in Decompensated Heart Failure with Volume Overload trial (ADVOR): baseline characteristics

Area of Science:

• Cardiology
• Pharmacology

Background:

• Acute heart failure (AHF) with volume overload is a significant clinical challenge.
• Standard diuretic therapy may not always achieve optimal decongestion.
• Investigating novel therapeutic strategies to enhance decongestion in AHF is crucial.

Purpose of the Study:

• To describe baseline characteristics of participants in the Acetazolamide in Decompensated Heart Failure with Volume Overload (ADVOR) trial.
• To compare ADVOR trial participants with those in other acute heart failure diuretic trials.
• To evaluate the efficacy of acetazolamide in improving decongestion in AHF.

Main Methods:

• The ADVOR trial randomized 519 patients with AHF and volume overload to receive intravenous acetazolamide or placebo.
• Participants received standardized loop diuretics, with stratification by left ventricular ejection fraction (LVEF).
• The primary endpoint was successful decongestion, defined by specific clinical and treatment criteria.

Main Results:

• The study enrolled elderly patients (mean age 78 years) with high NT-proBNP levels and significant congestion.
• Patients with lower LVEF (≤40%) exhibited distinct baseline characteristics, including higher NT-proBNP.
• ADVOR participants were older with higher NT-proBNP levels compared to other AHF diuretic trials, reflecting real-world conditions.

Conclusions:

• The ADVOR trial is the largest randomized diuretic trial in AHF to date, investigating acetazolamide's role.
• The study population represents a real-world elderly AHF cohort with impaired quality of life.
• The pragmatic design of ADVOR offers novel insights into diuretic treatment strategies for AHF.