Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Urinary sodium guidance for diuretics in acute heart failure is recommended but lacks robust data.
• The ENACT-HF study aimed to address this gap by investigating a standardized natriuresis-guided diuretic protocol.

Purpose of the Study:

• To assess the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in acute heart failure patients with volume overload.
• To compare this protocol against the standard of care in terms of natriuresis, diuresis, and clinical outcomes.

Main Methods:

• An international, multicenter, open-label, pragmatic study comparing a standardized diuretic protocol with standard care.
• The protocol utilized urinary sodium to guide diuretic therapy.
• Primary endpoint: natriuresis after 1 day. Secondary endpoints: cumulative natriuresis/diuresis, length of stay, in-hospital mortality.

Main Results:

• The standardized protocol arm showed significantly higher natriuresis at day 1 (1.64 ratio, P<0.001) and day 2 (1.52 ratio, P<0.001).
• Greater diuresis (1.33 ratio, P<0.001) and a shorter length of stay (0.87 ratio, P=0.036) were observed in the protocol arm.
• In-hospital mortality was similar between groups (1.4% vs 2.0%, P=0.852).

Conclusions:

• A standardized natriuresis-guided diuretic protocol is feasible and safe for managing acute heart failure.
• This protocol effectively enhances decongestion, leading to increased natriuresis and diuresis.
• The protocol also demonstrated a significant reduction in hospital length of stay.