Oral acetazolamide added to standard therapy did not improve the rate of achieving compensation in patients with decompensated heart failure compared to usual care (39.6% vs 39.7%; p=0.983).
RCT (n=416)
Open-label
1:1
Yes
Does oral acetazolamide improve clinical compensation in patients with decompensated heart failure?
Oral acetazolamide added to guideline-directed medical therapy did not improve clinical compensation in patients with decompensated heart failure, potentially due to high background use of SGLT2 inhibitors and ARNIs.
Absolute Event Rate: 39.6% vs 39.7%
p-value: p=0.983
Abstract Aim To study the efficacy and safety of acetazolamide administered orally to patients with decompensated HF at the hospital stage within 72 hours from admission, compared with standard therapy. Methods 416 patients with decompensated HF and NYHA class II-IV were enrolled into open-label, prospective, randomized, multicenter study. Patients were randomized 1:1 to either usual care (209 patients, M61,2%, aged 68 yrs) or acetazolamide oral administration (250 mg t.i.d during 72 hours) within 24 hours after randomization (207 patients, M64,3%, aged 67yrs). The primary endpoint was the number of patients who achieved compensation in accordance with the criteria for diuretic therapy discontinuation. Secondary endpoints: increase in urine output within the first 72 hours, weight loss, total LoS in hospital, LoS in the ICU, 6MWT at discharge from the hospital. FU was 90 days. Results The was no significant difference between two groups according to the main clinical, laboratory and instrumental features. NT-proBNP level was 1534.00 (612.75; 3592.50) pg/ml in patients in usual care group and 1445.45 (713.00; 3139.50) pg/ml in acetazolamide group (p=0.700). LV EF was 40.0 (30.0; 51.0) % 40.0 (30.0; 53.5) %, respectively (p=0.753). Patients of both groups received the same GDMT: SGLT2 inhibitors 73.2% vs. 76.3% (p=0.463), ACEi/ARB 62.7% vs. 60.4% (p=0.631), ARNI 22,6% vs 25,2% (p=0,439), beta-blockers 93.8% vs. 89.9% (p=0.372), MRA 89.5% vs. 88.4% (p=0.728), as well as diuretics, digoxin, statins, antiplatelet drugs/anticoagulants. The primary end-point has been reached in 83 (39.7%) patients in usual care group and in 82 (39.6%) patients in acetazolamide group (p=0.983). The urine output within 72 hours was 5825.0 (4826.0; 6926.0) ml vs. 6060.0 (5225.0; 7335.0) ml (p=0.028), weight loss within 72 hours - 3.00 (2.00; 5.00) kg vs. 3.00 (2.00; 5.10) kg (p=0.897), urine sodium concentration - 95.00 (63.74; 111.25) vs. 100.00 (65.36; 113.06), respectively (p=0.403). The length of hospital stay and ICU were the same 4.00 (4.00; 9.00) vs. 4.00 (4.00; 8.00) days, p=0.820 and 3.00 (3.00; 4.00) vs. 4.00 (3.00; 4.00) days, p=0.156 respectively. 6MWT results were 309.50 (282.50; 404.50) meters in usual care group vs. 300.00 (214.50; 347.00) meters in acetazolamide group (p=0.250). Conclusion Oral acetazolamide administration additionally to GDMT was not associated with better compensation of HF probably due to the high rate of administration of SGLT2i and ARNI.
Сабиров et al. (Sat,) conducted a rct in Decompensated heart failure (n=416). Oral acetazolamide vs. Usual care was evaluated on Achievement of compensation in accordance with the criteria for diuretic therapy discontinuation (p=0.983). Oral acetazolamide added to standard therapy did not improve the rate of achieving compensation in patients with decompensated heart failure compared to usual care (39.6% vs 39.7%; p=0.983).