Pragmatic Urinary Sodium-Based Algorithm in Acute Heart Failure - PUSH-AHF

Sep 25, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Dutch Heart Foundation
Date Presented:
08/28/2023
Date Published:
08/28/2023
Date Updated:
09/25/2023
Original Posted Date:
08/28/2023
References

Contribution To Literature:

The PUSH-AHF trial showed that natriuresis-guided therapy improves natriuresis; however, this strategy did not improve clinical outcomes.

Description:

The goal of the trial was to evaluate natriuresis-guided therapy compared with usual care among patients with acute decompensated heart failure.

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients with acute decompensated heart failure were randomized to natriuresis-guided therapy (n = 150) vs. usual care (n = 160). In the natriuresis-guided group, urine sodium was evaluated at 2, 6, 12, 18, 24, and 36 hours. Diuretic treatment was intensified if urine sodium level was low (<70 mmol/L). 

  • Total number of enrollees: 310
  • Duration of follow-up: 180 days
  • Mean patient age: 74 years
  • Percentage female: 45%

Inclusion criteria:

  • Patients admitted with acute decompensated heart failure
  • Planned treatment with a loop diuretic

Principal Findings:

The co-primary outcome, natriuresis at 24 hours, was 409 mmol in the natriuresis-guided group vs. 345 mmol in the usual care group (p = 0.0061).

The co-primary outcome of all-cause mortality or heart failure hospitalization at 180 days was 31% in the natriuresis-guided group vs. 31% in the usual care group (p = 0.70).

Interpretation:

Among patients with acute decompensated heart failure, natriuresis-guided therapy improves natriuresis compared with usual care. Natriuresis-guided therapy did not improve clinical outcomes. This strategy deserves further study.

References:

ter Maaten JM, Beldhuis IE, van der Meer P, et al. Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial. Nat Med 2023;Aug 28:[Epub ahead of print].

Presented by Dr. Jozine Ter Maaten at the European Society of Cardiology Congress, Amsterdam, Netherlands, August 28, 2023.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Acute Heart Failure, Diuretics, ESC Congress, Heart Failure, Natriuresis


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