Peripheral Venous Pressure-Guided Decongestive Therapy in Heart Failure 2 (PERIPHERAL-HF2)

Area of Science:

• Cardiology
• Clinical Trials
• Nephrology

Background:

• Congestive symptoms drive heart failure (HF) hospitalizations, with diuretics as primary treatment.
• Current diuretic management lacks objective congestion measures, leading to suboptimal decongestion and higher readmission rates.
• Peripheral venous pressure (PVP) offers a potential noninvasive method to quantify vascular congestion.

Purpose of the Study:

• To evaluate the efficacy of peripheral venous pressure (PVP)-guided diuretic therapy compared to standard care in managing acute heart failure.
• To determine if PVP-guided therapy reduces composite outcomes of mortality, hospitalizations, and emergency department visits.
• To assess the impact of PVP-guided therapy on cardiovascular mortality and HF-related readmissions.

Main Methods:

• A randomized trial enrolling 650 patients (18-99 years) with de novo or acutely decompensated chronic HF.
• Standard care arm: physician-directed diuretic use and discharge decisions.
• PVP-guided arm: daily PVP monitoring with a target <9 mmHg, adjusting diuretics and urine output accordingly.

Main Results:

• Primary outcome: composite of all-cause mortality, hospitalizations, and emergency department visits.
• Secondary outcomes: cardiovascular mortality and HF-related readmissions.
• Hypothesis: PVP-guided therapy will achieve more precise decongestion, lowering rehospitalizations and mortality.

Conclusions:

• PVP-guided diuretic therapy shows promise for optimizing decongestion in heart failure.
• This approach may lead to improved clinical outcomes, including reduced hospital readmissions and mortality.
• Further insights into the interplay of diuretic therapy, vascular congestion, and cardiac/renal outcomes are expected.