Acetazolamide or Metolazone in Acute Heart Failure

Launched by CLINICA ALEMANA DE SANTIAGO · Feb 14, 2024

Keywords

ClinConnect Summary

The ACME-AHF trial is a research study aimed at finding out which combination of diuretics, acetazolamide or metolazone with furosemide, is more effective and safe for treating patients hospitalized with acute heart failure. Acute heart failure is a serious condition where the heart cannot pump blood effectively, leading to fluid buildup and symptoms like shortness of breath. This trial will focus on how quickly and effectively these medications can relieve congestion, which is important because not treating it properly can lead to more hospital visits and serious health issues.

To participate in the trial, individuals must be between 65 and 74 years old and have been admitted to the hospital with symptoms of acute heart failure, showing clear signs of fluid buildup. Participants will be randomly assigned to receive one of the diuretic combinations within 24 hours of their hospital admission. Throughout the study, researchers will monitor how well the treatment works in reducing congestion and improving overall health. It's important to note that certain conditions, such as severe kidney problems or being pregnant, may exclude someone from participating.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Acute heart failure: Hospitalization due to symptoms of heart failure, congestion signs documented with a congestion score greater than 1, NT-proBNP above 1000 pg/ml.
• • Randomization within 24 hours of admission.
• Exclusion Criteria:
• • Under 18 years of age.
• • Received more than one dose of intravenous furosemide before randomization.
• • Cause of heart failure: hypertrophic or restrictive cardiomyopathy, or constrictive pericarditis.
• • Acute coronary syndrome or severe acute valvulopathy as the cause of decompensation.
• • Systolic blood pressure \< 90mmHg before randomization.
• • Requirement for vasopressors, inotropes, or invasive mechanical ventilation. Use of intravenous vasodilators or non-invasive mechanical ventilation is allowed.
• • Glomerular filtration rate \< 20ml/min/1.73m2.
• • Potassium \< 2.5 mEQ/L or Sodium \< 125 mEQ/L before randomization.
• • pH \< 7.2 or Bicarbonate \< 15mEQ/L before randomization.
• • Use of another diuretic in addition to furosemide before randomization. Dapagliflozin or Empagliflozin can be maintained upon admission or initiated early during hospitalization if desired by the treating physician (variable to be recorded).
• • Patients who cannot achieve adequate recording of variables (e.g., inability to quantify diuresis or weight).
• • Pregnant or lactating individuals. If of childbearing age and there is inconsistency with contraceptive use or reasonable doubts about current pregnancy, a pregnancy test must be conducted before study entry.