Current HFA-ESC guidelines for diuretics in acute heart failure led to significant increases in natriuresis and diuresis over 2 days compared with usual care, in ENACT-HF. MedicalNews
In patients with acute heart failure, a urine sodium-guided diuretic protocol, currently recommended in guidelines from the Heart Failure Association of the European Society of Cardiology , led to significant increases in natriuresis and diuresis over 2 days in the prospective ENACT-HF clinical trial.with expert consensus, but had not been tested prospectively, Jeroen Dauw, MD, of AZ Sint-Lucas Ghent, Ghent, Belgium, explained in a presentation May 22 at HFA-ESC 2023.
Therefore, 401 patients participated, 254 in the SOC arm and 147 in the protocol arm, because of the sequential nature of the study; that is, patients in the SOC arm of the two-phase study were recruited first. In the protocol phase, patients were treated with twice the oral home dose as an IV bolus."This meant if, for example, you have 40 mg of furosemide at home, then you receive 80 mg as a first bolus," Dauw told attendees. A spot urine sample was taken after 2 hours, and the response was evaluated after 6 hours. A urine sodium above 50 millimoles per liter was considered a good response.
Furthermore, Dauw said, there was no interaction on the endpoints with SGLT2 inhibitor use at baseline.However, there was no significant difference in weight loss and no difference in the congestion score. A session chair asked why only patients already on diuretics were included in the study, noting that in his clinic, about half of the admissions are de novo.
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