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Hypertonic saline not effective in ambulatory HF patients?

Presented by
Dr Marta Cobo Marcos, Iron Gate Majadahonda University Hospital, Spain
HFA 2024
Phase 3, SALT-HF
A single infusion of IV furosemide with added hypertonic saline solution (HSS) failed to show a significant increase in short-term diuresis, nor improvement in other congestion parameters compared with IV furosemide alone in HF outpatients. This was the main result of the phase 3 SALT-HF study.

Numerous studies have suggested that HSS may improve diuretic response and outcomes in hospitalised heart failure (HF) patients, though this has never translated into strong guideline recommendations. Less is known about the efficacy and safety of hypertonic treatment in ambulatory patients with worsening HF. The SALT-HF trial (NCT04533997), presented by Dr Marta Cobo Marcos (Iron Gate Majadahonda University Hospital, Spain), explored if the addition of HSS to IV furosemide increased 3-hour diuresis or had other positive effects [1].

Dr Cobo Marcos explained that the study included patients with worsening HF plus 2 signs of volume overload; with a daily oral loop diuretic dose of ≥80 mg furosemide or equivalent for ≥30 days; a NT-proBNP >1,000 pg/mL or BNP > 250 pg/mL; and with a need for intravenous diuretic therapy. The 168 participants were randomised 1:1 to IV furosemide plus HSS or IV furosemide alone.

The primary outcome of 3-hour diuresis volume did not differ between the groups: 1,099 mL in the HSS group compared with 1,103 mL in the control group (mean difference -4.6 mL; P=0.963). Neither was there a significant difference in 3-hour natriuresis volume or 3-hour weight difference. There were no differences between the groups in any of the other secondary outcomes, assessed 7 days after treatment: NYHA score and VAS score, composite congestion score, body weight difference, inferior vena cava diameter, lung ultrasound B-lines, and biomarker scores. Dr Cobo Marcos offered as a possible explanation for the negative results that a single infusion or a 3-hour evaluation period may have been insufficient to show any benefits. The overall safety profile of HSS was deemed appropriate.

  1. Marcos MC, et al. Efficacy of hypertonic saline therapy in ambulatory patients with heart failure. Heart Failure 2024, 11–14 May, Lisbon, Portugal.

Medical writing support was provided by Michiel Tent.
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