Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study
Por:
Dauw, J, Charaya, K, Lelonek, M, Zegri-Reiriz, I, Nasr, S, Paredes-Paucar, CP, Borbély, A, Erdal, F, Benkouar, R, Cobo-Marcos, M, Barge-Caballero, G, George, V, Zara, C, Ross, NT, Barker, D, Lekhakul, A, Frea, S, Ghazi, AM, Knappe, D, Doghmi, N, Klincheva, M, Fialho, I, Bovolo, V, Findeisen, H, Alhaddad, IA, Galluzzo, A, de la Espriella, R, Tabbalat, R, Miró, O, Singh, JS, Nijst, P, Dupont, M, Martens, P, Mullens, W
Publicada:
1 ene 2024
Resumen:
Background: The use of urinary sodium to guide diuretics in acute heart failure is recommended by experts and the most recent European Society of Cardiology guidelines. However, there are limited data to support this recommendation. The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure and signs of volume overload.Methods: ENACT-HF was an international, multicenter, open-label, pragmatic, 2-phase study, comparing the current standard of care of each center with a standardized diuretic protocol, including urinary sodium to guide therapy. The primary end point was natriuresis after 1 day. Secondary end points included cumulative natriuresis and diuresis after 2 days of treatment, length of stay, and in-hospital mortality. All end points were adjusted for baseline differences between both treatment arms.Results: Four hundred one patients from 29 centers in 18 countries worldwide were included in the study. The natriuresis after 1 day was significantly higher in the protocol arm compared with the standard of care arm (282 versus 174 mmol; adjusted mean ratio, 1.64; P<0.001). After 2 days, the natriuresis remained higher in the protocol arm (538 versus 365 mmol; adjusted mean ratio, 1.52; P<0.001), with a significantly higher diuresis (5776 versus 4381 mL; adjusted mean ratio, 1.33; P<0.001). The protocol arm had a shorter length of stay (5.8 versus 7.0 days; adjusted mean ratio, 0.87; P=0.036). In-hospital mortality was low and did not significantly differ between the 2 arms (1.4% versus 2.0%; P=0.852).Conclusions: A standardized natriuresis-guided diuretic protocol to guide decongestion in acute heart failure was feasible, safe, and resulted in higher natriuresis and diuresis, as well as a shorter length of stay.
Filiaciones:
Dauw, J:
Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium
UHasselt, Doctoral Sch Med & Life Sci, LCRC, Diepenbeek, Belgium
Charaya, K:
First Moscow State Med Univ, Dept Cardiol Sonog & Funct Diagnost, Moscow, Russia
Lelonek, M:
Med Univ Lodz, Dept Noninvas Cardiol, Lodz, Poland
Zegri-Reiriz, I:
Hosp Santa Creu & Sant Pau, Dept Cardiol, Heart Failure & Heart Transplant Unit, Barcelona 08025, Spain
Nasr, S:
Balamand Univ Med Ctr, Dept Cardiol, Mt Lebanon Hosp, Hazmiyeh, Lebanon
Paredes-Paucar, CP:
Inst Nacl Cardiol Ignacio Chavez, Mexico City, DF, Mexico
Borbély, A:
Univ Debrecen, Fac Med, Dept Cardiol, Debrecen, Hungary
Erdal, F:
Med Spectrum Twente, Thorax Ctr Twente, Dept Cardiol, Enschede, Netherlands
Benkouar, R:
Univ Algiers, Benyoucef Benkhedda Fac Med, Mustapha Pacha Hosp, Algiers, Algeria
Cobo-Marcos, M:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Barge-Caballero, G:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
George, V:
Pushpagiri Inst Med Sci, Tiruvalla, India
Zara, C:
Theracardia, Brasov, Romania
Ross, NT:
Kuala Lumpur Gen Hosp, Kuala Lumpur, Malaysia
Barker, D:
Univ Hosp North Midlands, Stoke On Trent, Staffs, England
Lekhakul, A:
Wetchakarunrasm Hosp, Bangkok, Thailand
Frea, S:
Citta Salute & Sci Univ Hosp Torino, Div Cardiol, Turin, Italy
Ghazi, AM:
Natl Heart Inst, Kuala Lumpur, Malaysia
Knappe, D:
Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany
Doghmi, N:
Mohammed V Univ, CHU Ibn Sina, Dept Cardiol, Rabat, Morocco
Klincheva, M:
Zan Mitrev Clin, Skopje, North Macedonia
Fialho, I:
Hosp Prof Doutor Fernando Fonseca, Dept Cardiol, Amadora, Portugal
Bovolo, V:
Michele & Pietro Ferrero Hosp, Dept Cardiol, Verduno, Italy
Findeisen, H:
Red Cross Hosp, Dept Internal Med, Bremen, Germany
Alhaddad, IA:
Jordan Hosp, Amman, Jordan
Galluzzo, A:
Osped SantAndrea, Vercelli, Italy
de la Espriella, R:
Hosp Clin Univ Valencia, Cardiol Dept, Valencia, Spain
Tabbalat, R:
Abdali Hosp, Dept Cardiol, Amman, Jordan
Miró, O:
Univ Barcelona, Hosp Clin Barcelona, IDIBAPS, Emergency Dept Hosp, Barcelona, Catalonia, Spain
Singh, JS:
Royal Infirm Edinburgh NHS Trust, Heart Ctr, Edinburgh, Midlothian, Scotland
Nijst, P:
Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium
Dupont, M:
Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium
Martens, P:
Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium
Mullens, W:
UHasselt, Doctoral Sch Med & Life Sci, LCRC, Diepenbeek, Belgium
UHasselt, Biomed Res Inst, Fac Med & Life Sci, LCRC, Diepenbeek, Belgium
Hosp Univ Puerta Hierro Majadahonda IDIPHISA, Dept Cardiol, Madrid, Spain
Univ A Coruna, Complexo Hosp Univ A Coruna CHUAC, Adv Heart Failure & Heart Transplant Unit, Dept Cardiol,Serv Galego Saude SERGAS, La Coruna, Spain
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