Pragmatic Urinary Sodium-Based Algorithm in Acute Heart Failure - PUSH-AHF
Contribution To Literature:
The PUSH-AHF trial showed that natriuresis-guided therapy improves natriuresis; however, this strategy did not improve clinical outcomes.
The goal of the trial was to evaluate natriuresis-guided therapy compared with usual care among patients with acute decompensated heart failure.
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%
- Patients admitted with acute decompensated heart failure
- Planned treatment with a loop diuretic
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).
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.
Presented by Dr. Jozine Ter Maaten at the European Society of Cardiology Congress, Amsterdam, Netherlands, August 28, 2023.
Keywords: Acute Heart Failure, Diuretics, ESC Congress, Heart Failure, Natriuresis
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