A nurse-based strategy reduces heart failure morbidity in patients admitted for acute decompensated heart failure in Brazil: the HELEN-II clinical trial

2014 ◽  
Vol 16 (9) ◽  
pp. 1002-1008 ◽  
Author(s):  
Emiliane Nogueira de Souza ◽  
Luis Eduardo Rohde ◽  
Karen Brasil Ruschel ◽  
Cláudia Mota Mussi ◽  
Luis Beck-da-Silva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

scholarly journals Effect of adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure: a randomized clinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Diogo Silva Piardi ◽  
Maurício Butzke ◽  
Ana Carolina Martins Mazzuca ◽  
Bruna Sessim Gomes ◽  
Sofia Giusti Alves ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Weight Reduction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
World Health ◽  
Clinical Trial Registry ◽  
Usual Treatment ◽  
Significant Difference

AbstractAcute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized—26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: − 1.78 ± 1.08 kg/day vs placebo: − 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: − 0.74 ± 0.47 kg/40 mg vs placebo: − 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/.

Abstract 16958: ADHERE Risk Levels Predict 60-day Death and Re-hospitalization in Clinical Trial Patients with Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Virginia B Hebl ◽  
Susanna R Stevens ◽  
Hiroyuki Takahama ◽  
Bradley A Bart ◽  
Horng H Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Low Risk ◽  
Research Network ◽  
Risk Level ◽  
Study Cohort ◽  
Risk Levels ◽  
Baseline Characteristics

Background: The Acute Decompensated Heart Failure National Registry (ADHERE) risk levels are a validated tool to assess the risk of in-hospital mortality in patients with acute decompensated heart failure (ADHF). The objective of this study is to determine if the risk levels predict 60-day outcomes in well-defined ADHF patients from NIH Heart Failure Clinical Research Network (HFCRN) trials. Methods: Our study cohort included 835 unique patients with ADHF enrolled in 3 NIH HFCRN trials: Diuretic Optimization Strategies Evaluation (DOSE), CARdiorenal REScue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation (ROSE). ADHERE risk level was assigned, as previously described, by baseline BUN (<43 vs. ≥43 mg/dL), Cr (<2.2 vs. ≥2.2, a modification from 2.75 mg/dL used in ADHERE due the Cr distribution in our study population), and systolic BP (≥ 115 vs < 115 mmHg). Baseline characteristics and outcomes were compared between risk levels. Results: Of the 835 patients enrolled in DOSE (308), CARRESS-HF (188), and ROSE (360), an ADHERE risk level could be assigned to 830, with 62 (8%) high, 521 (63%) intermediate, 247 (30%) low risk. Baseline characteristics (Table 1) and outcomes (Table 2), including combined 60-day death and re-hospitalization (hazard ratio 1.94, high risk versus low risk, p<0.01), varied by ADHERE risk level. Conclusion: ADHERE risk levels predict 60-day death and re-hospitalization rates in patients with ADHF. These results extend the utility of the ADHERE risk levels, by informing longer-term clinical decisions regarding advanced heart failure treatment, care transition strategies and clinical trial design.

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