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Eligibility for acetazolamide in patients with decompensated heart failure
Session:
Posters (Sessão 5 - Écran 2) - Insuficiência cardíaca - tratamento farmacológico
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Filipa Gerardo; Inês Fialho; Mariana Passos; Inês Miranda; Carolina Mateus; Marco Beringuilho; Joana Lima Lopes; Daniel Faria; David Roque
Abstract
<p style="text-align:center"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Title:</strong> Eligibility for acetazolamide in patients with decompensated heart failure</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212121">Background</span></span></strong><span style="background-color:white"><span style="color:#212121">: The </span></span><span style="background-color:white"><span style="color:black">Acetazolamide in Decompensated heart failure with Volume OveRload (ADVOR) is a randomized controlled trial that brought new insights in achieving successful decongestion with acetazolamide. </span></span><span style="color:black">However, the numerous and strict enrollment criteria may limit reproducibility of the trial results in clinical practice</span><span style="color:#505050">.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212121">Purpose</span></span></strong><span style="background-color:white"><span style="color:#212121">: To estimate the eligibility for participation in ADVOR trial in real-world hospitalized patients with decompensated heart failure (HF).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We applied the enrollment criteria of ADVOR to decompensated HF patients who were admitted in a Cardiology unit of a single center between March 2021 and September 2022.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#212529">Results: </span></strong><span style="color:#212529">A total of 137 electronic medical charts were reviewed. </span>The inclusion criteria were fulfilled by 30.66% (n=42) of patients. The two least achieved inclusion criteria were (1) a congestion score </span></span>≥ <span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">2 (a multivariable score ranging from 0-10 created for the ADVOR trial, composed of oedema, ascites or pleural effusion confirmed by echography or chest X-ray) accomplished by only 67.15% of patients, and (2) a maintenance treatment with at least 40mg of furosemide the previous month (55.47% of patients). The latter was further analysed, as many of decompensated heart failure patients were not previously diagnosed (43.07% in total) and were medication noncompliant. The most common reason for exclusion was concomitant treatment with sodium-glucose co-transporter-2 (SGLT2) inhibitor (30.95% of those fulfilling the inclusion criteria). After both inclusion and exclusion criteria, <span style="color:#212529">the proportion of patients eligible were 13.87% (n=19).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>Approximately 86.13% of real-world patients are not eligible for the decongestive treatment with acetazolamide applied in a highly controlled randomized trial. The almost universal use of SLGT2 inhibitors limits the reproducibility of the ADVOR study. The attempt to create a congestive score for decompensated HF patients seems to fail for adequate volume assessment in real-world patients. </span></span></p>
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