Acetazolamide in Decompensated Heart failure

1. Acetazolamide in Acute
Decompensated Heart Failure with
Volume Overload

2. Introduction
Objectives
Methodology
Results
Conclusions

3. Introduction
Current guidelines recommend the use of I.V loop
diuretics
• Ameliorate symptoms of fluid overload in patients
with acute decompensated heart failure
Use of high-dose loop diuretics (2 to 2.5 times the
oral maintenance dose)
• Any patients are discharged from the hospital with
residual clinical signs of volume overload
• Strong predictor of poor outcome

4. 15% of the patients were free from
clinical congestion after 72 hours of
treatment
Conclusion
• No significant differences in patients’ global assessment of symptoms or in the change in renal function
when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose
as compared with a low dose
N Engl J Med 2011;364:797-805

5. Approximately 20% of the patients were discharged from
the hospital with an increase in body weigh
Circulation: Heart Failure 2.1 (2009): 56-62.

6. Objectives
Addition of acetazolamide to standardized intravenous loop-diuretic therapy
would improve the incidence of successful decongestion among patients with
acute decompensated heart failure.

7. Study Design
▪ Multicenter, parallel-group, double-blind, randomized, placebo-controlled trial
▪ 519 Patients with acute decompensated heart failure, clinical signs of volume overload, and
elevated Natriuretic peptide levels
Primary end point
• Successful decongestion within 3 days after randomization
• Without an indication for escalation of decongestive therapy.
Secondary end points
• Included a composite of death from any cause or
rehospitalization for heart failure during 3 months of follow-up
• Safety was also assessed.

8. Results
• Acetazolamide grp: 108 of 256 patients (42.2%)
• Placebo grp: 79 of 259 (30.5%) (risk ratio, 1.46; 95% confidence interval [CI], 1.17 to 1.82;
P<0.001)
Successful decongestion occurred in
• Acetazolamide grp: 76 of 256 patients (29.7%)
• Placebo grp: 72 of 259 patients (27.8%) in the placebo group (hazard ratio, 1.07; 95% CI, 0.78 to
1.48).
Death from any cause or rehospitalization for heart failure
• Higher cumulative urine output and natriuresis, findings consistent with better diuretic efficiency
Acetazolamide treatment was associated with
• Similar in the two groups
Incidence of worsening kidney function, hypokalemia, hypotension, and
adverse events was

9. Primary End point
Significance of Acetazolamide added to Loop’s Diuretics
• Acetazolamide grp: 108 of 256 patients (42.2%)
• Placebo grp: 79 of 259 (30.5%) (risk ratio, 1.46;
95% confidence interval [CI], 1.17 to 1.82;
P<0.001)
Successful decongestion
occurred in

10. Composite Secondary End Point
• Acetazolamide grp: 76 of 256 patients
(29.7%)
• Placebo grp: 72 of 259 patients (27.8%) in
the placebo group (hazard ratio, 1.07; 95%
CI, 0.78 to 1.48).
Death from any cause or
rehospitalization for heart failure

11. Adverse Events
▪ Incidence of adverse events during 3 months of follow-up was similar in the
two trial groups

12. Conclusions
▪ The addition of acetazolamide to loop diuretic therapy in patients with acute
decompensated heart failure resulted in a greater incidence of successful
decongestion

13. Summary

14. Thank You