Acetazolamide in Acute Decompensated Heart Failure with Volume Overload

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Acute decompensated heart failure (ADHF) often involves fluid overload, necessitating effective decongestion.
• Loop diuretics are standard therapy, but their efficiency can be limited.
• The role of acetazolamide, a carbonic anhydrase inhibitor, in enhancing loop diuretic efficacy for ADHF is not well-established.

Purpose of the Study:

• To investigate whether acetazolamide improves decongestion in patients with ADHF and volume overload.
• To assess the impact of acetazolamide on diuretic efficiency and patient outcomes.

Main Methods:

• A multicenter, double-blind, randomized, placebo-controlled trial involving 519 patients with ADHF and signs of volume overload.
• Patients received either intravenous acetazolamide or placebo, in addition to standard intravenous loop diuretics.
• Decongestion success, defined by absence of volume overload signs within 3 days, was the primary endpoint.

Main Results:

• Successful decongestion occurred in 42.2% of patients receiving acetazolamide versus 30.5% in the placebo group (risk ratio, 1.46; P<0.001).
• Acetazolamide treatment led to increased urine output and natriuresis, indicating enhanced diuretic efficiency.
• Rates of death, rehospitalization, worsening kidney function, hypokalemia, and hypotension were similar between groups.

Conclusions:

• Adding acetazolamide to loop diuretics significantly increases the success rate of decongestion in patients with ADHF.
• This combination therapy improves diuretic efficiency without a significant increase in adverse events.
• Acetazolamide represents a valuable adjunct for managing fluid overload in ADHF.