Tailored Urine Sodium Guided Diuretic Treatment in Adults Hospitalized with Acute Heart Failure to Improve Survival and Symptoms

What this Trial Is About

Acutely decompensated heart failure ADHF is a common and serious condition that places a heavy financial and health burden on the healthcare system. This research aims to evaluate whether using urine sodium levels to guide diuretic treatment can improve patient outcomes compared to usual care. The study focuses on whether this tailored approach can lead to faster and more complete removal of excess fluid, potentially improving survival and reducing heart failure events, while maintaining safety especially regarding kidney function. Participants are randomly assigned to one of two groups one group receives a tailored, urine sodium guided intensified diuretic treatment, where intravenous loop diuretics are adjusted based on urine sodium measurements during the first 72 hours of admission the other group receives usual care with diuretic treatment decided by their physician. Both groups are advised to receive acetazolamide in the first 72 hours. Diuretics are given intravenously soon after diagnosis and continued three times daily until recompensation. During the study, participants are monitored for a variety of outcomes including death, heart failure events, and changes in quality of life measured by the Kansas City Cardiomyopathy Questionnaire. Other assessments include NT-proBNP levels, clinical congestion scores, weight changes, and kidney function over a 90-day follow-up period. Hospital stays, outpatient visits, and adverse events are also tracked. The study uses a double-blinded, randomized design with a primary outcome measured 90 days after inclusion.

Investigating a Tailored Diuretic Algorithm in Acute Heart Failure Patients