05:30am Monday 23 September 2019

Ultrafiltration may not be best approach for heart failure patients

Study Highlights:
  • Ultrafiltration, which removes excess fluid from the body, was no better than an aggressive diuretic-based approach in reducing congestion in heart failure patients.
  • Diuretics and ultrafiltration achieved similar fluid removal, but kidney function was worse among patients treated with ultrafiltration.
  • Ultrafiltration did not reduce recurrent hospitalizations for heart failure.
The full manuscript for Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) is published in the New England Journal of Medicine.
Excess fluid build-up in the body can occur in many heart failure patients and lead to a need to hospitalize these patients. For decades, physicians have used intravenous drugs known as diuretics to remove excess fluid. Many heart failure patients may have some degree of abnormality in kidney function and diuretics can lead to further worsening of kidney function.
“We need better treatments for managing hospitalized heart failure patients, but our findings indicate that ultrafiltration may not be the answer,” said Bradley Bart, M.D., lead author of the study and chief of cardiology at Hennepin County Medical Center in Minneapolis, Minn.
In the prospective randomized comparison of the treatments, researchers randomly assigned ultrafiltration or a diuretic-based approach to 188 hospitalized patients (average age 68, mostly male) with persistent excess fluid and worsening kidney function. Eighty-four percent had high blood pressure; 66 percent had diabetes; and 75 percent had at least one recent admission to the hospital for heart failure.
Researchers measured the patients’ weight change (as a measure of improved congestion and fluid loss) and kidney function four days after starting treatment, and followed patients for 60 days to see if they remained stable and out of the hospital.
Both groups lost about 12 pounds during the first four days of treatment. Kidney function worsened in ultrafiltration patients and they also had more side effects. After 60 days, there were no differences between the two groups in either heart failure hospitalizations or death.
“Ultrafiltration is more expensive, more complex and doesn’t offer any advantage as administered in this study,” Bart said.
“The overall disappointing results of this trial indicate that more research is needed to find better ways to treat these seriously ill patients,” said Eugene Braunwald, co-author and chair of the Heart Failure Network that conducted the study.
Other co-authors are Steven R. Goldsmith, M.D.; Kerry L. Lee, Ph.D.; Michael M. Givertz, M.D.; Christopher M. O’Connor, M.D.;  David A. Bull, M.D.;Margaret M. Redfield, M.D.; Anita Deswal, M.D., M.P.H.; Jean L. Rouleau, M.D.; Martin M. LeWinter, M.D.; Elizabeth O. Ofili, M.D., M.P.H.; Lynne W. Stevenson, M.D.; Marc J. Semigran, M.D.; G. Michael Felker, M.D.; Horng H. Chen, M.D.; Adrian F. Hernandez, M.D.; Kevin J. Anstrom, Ph.D.; Steven E. McNulty, M.S.; Eric J. Velazquez, M.D.; Jenny C. Ibarra, R.N., M.S.N.; and Alice M. Mascette, M.D.
The National Heart, Lung, and Blood Institute funded the study.
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Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding External link.
Note: The CARRESS-HF presentation is 5:13 p.m. PT, Tuesday, Nov. 6, in Petree Hall D.
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