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Acetazolamide efficacy and safety in patients with acute heart failure with volume overload: a Systematic Review and Meta-Analysis.
Session:
Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker:
Bernardo Manuel Lisboa Resende
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Bernardo Lisboa Resende; Gonçalo Ferraz Costa; Rafaela Fernandes; Tomás M. Carlos; Luísa Gomes Rocha; Mafalda Griné; Gonçalo Terleira Batista; Ana Luísa Silva; Mariana Simões; Tatiana Santos; João Gameiro; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Background: </strong>Diuretics are the cornerstone therapy in acute heart failure (AHF) with fluid overload, and loop diuretics are the favoured drugs, due to their efficacy and rapid onset. Insufficient diuretic response remains a clinical challenge, and current guidelines behold the concomitant administration of other diuretics. In a recent randomized clinical trial, the addition of acetazolamide to conventional diuretic therapy increased clinical decongestion, however evidence supporting its use in AHF is still limited. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Aim: E</strong>valuate the efficacy and safety of acetazolamide addition to intravenous diuretic therapy, in patients with acute decompensated heart failure.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods: </strong>We systematically checked the Cochrane Controlled Register of Trials, EMBASE and PubMed for both interventional and observational studies comparing acetazolamide on top of conventional loop diuretic therapy versus conventional loop diuretic regimens. Primary outcomes were successful clinical decongestion and worsening renal function or acute renal injury (AKI). Secondary endpoints were weight loss at 48 hours and rehospitalization for heart failure or all-cause mortality at 3 months. We excluded studies reporting other experimental strategies and that didn't encompass full-text article or the selected outcomes. Our meta-analysis was conducted on a random effects model, considering a 95% confidence interval.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results: </strong>Of the 670 records from our search strategy, 7 studies were included, providing a total of 3.421 patients. Our meta-analysis revealed increased rates of successful clinical decongestion (pooled odds ratio (OR) 1,57 [1,13<span style="font-family:Symbol">-</span>2,18], P<0,75, I²= 0%), without statistical significance in worsening renal function or AKI (pooled instrumental variables 1,31 [0,51<span style="font-family:Symbol">-</span>3,34], P=0,05, I²= 61%), despite a tendency favouring the control group. Regarding secondary outcomes, the addition of acetazolamide revealed increased weight loss (pooled mean difference -0,70 [(-1,64)<span style="font-family:Symbol">-</span>(-0.07)] kg, P=0,21, I²= 36%), although there was no statistical significance between groups concerning rehospitalization for heart failure or all-cause mortality at 3 months (pooled OR 1,06 [0,73<span style="font-family:Symbol">-</span>1.53], P=0,48, I²= 0%).</span></span></p> <p style="text-align:justify"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusions: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">In general, our study provides important data regarding the clinical benefits of introducing acetazolamide in the management of patients with acute heart failure with volume overload, respecting to increased rates of successful decongestion and weight loss.</span></span></p>
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