Individualised diuretic titration in acute HF without a physician

EASY-HF is the first study to demonstrate that a nurse-led, natriuresis-guided, diuretic protocol through a point-of-care (POC) sensor is feasible and safe. The results showed significant improvements in natriuresis after 48 hours, without an increased incidence of adverse events.

The single-centre, randomised, open-label EASY-HF trial (NCT06278792) tested the hypothesis that a nurse-led diuretic titration algorithm, informed by a point-of-care urine sodium device, could achieve greater natriuresis than physician-led standard-of-care [1]. Dr Evelyne Meekers (Hospital Oost-Limburg, Belgium) and colleagues wanted to find a way to implement the demanding protocol of natriuresis-guided diuretic therapy in patients with acute HF, which has recently been shown to improve decongestion and clinical outcomes [2].

EASY-HF enrolled 60 participants with HF and signs of congestion and volume overload, with NT-proBNP >500 ng/L (>800 ng/L in case of atrial fibrillation). Participants were randomised to standard-of-care diuretic management at the treating physician's discretion, or to a nurse-led natriuresis-guided protocol. A POC sensor (the UNa sensor) was used to measure the urinary sodium content. The primary endpoint was total natriuresis after 48 hours.

Natriuresis after 48 hours was significantly higher in the nurse-led group (820.0±279.0) than in the standard-of-care group (657.4±272.7), with an absolute difference of 163 (P=0.027). Dr Meekers observed that the largest benefit was achieved on the second day of treatment. She explained that the greater natriuresis in the nurse-led group was due to more frequent per-protocol changes in the dosage and higher dosing. Diuresis after 48 hours was also significantly higher in the nurse-led group: 7.3±2.4 L versus 6.0±1.9 L, with an absolute difference of 1.3 L (P=0.019). The nurses considered both the UNa sensor and the protocol easy to use. There was no significant difference in the incidence of hypotension, hypokalaemia, or renal dysfunction.

Dr Meekers noted that the POC UNa sensor provides a readily available bedside urinary sodium analysis, enabling the nurse to adjust diuretics rapidly. “The protocol and the POC UNa sensor were considered easily usable and adaptable, and were preferred to 24-hour urgent care in daily clinical practice by the nursing team, giving them tools for self-empowerment.” “The combination of a standardised protocol and the POC UNa sensor allows individualised diuretic titration during the first 48 hours in patients with acute decompensated HF) without the interference of a physician,” concluded Dr Meekers.

1. 
   
   1. Meekers E, et al. Readily available urinary sodium analysis in patients with acute decompensated heart failure. Late breaking clinical trials: medical therapy, Heart Failure 2024, 11–14 May, Lisbon, Portugal.
   2. Ter Maaten JM, et al. Nat Med. 2023;29:2625–32.

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Posted on 16 July 202416 July 2024