Three diuretic regimens compared in the DEA-HF study

Intravenous (IV) furosemide plus metolazone resulted in significantly higher natriuresis compared with IV furosemide alone in patients with chronic heart failure (HF). This was one of the main conclusions of the DEA-HF study, which compared 3 commonly used, furosemide-based diuretic regimens.

The single-centre DEA-HF study (NCT05904808) assessed the efficacy and safety of 3 diuretic regimens used commonly in daily practice to treat congestion-refractory, ambulatory chronic HF [1]. Dr Aharon Abbo (Rambam Medical Center, Israel), who presented the study results, said that there is a need for comparative studies to guide contemporary diuretic regimen selection for these patients. Key inclusion criteria of the DEA-HF study were NYHA class II–IV; ≥1 sign of congestion; haemodynamic stability; ≥2 HF drugs plus oral diuretics for 1 month; and rate >20 mL/min/1.73m².

Three regimens of 3 weeks each were evaluated: 1) 250 mg of IV furosemide; 2) 250 mg of IV furosemide plus 5 mg of oral metolazone; 3) 250 mg of IV furosemide plus 500 mg of IV acetazolamide. The 42 participants were randomised to receive the 3 different regimens in 6 possible sequences. Each participant was followed for 4 consecutive weeks. The median age was 72 years, 60% were men, and most (79%) participants were NYHA class III. The trial was completed by 37 participants.

The primary outcome was sodium excretion 6 hours after treatment. For For regimen 1, this was 3,835 mg (95% CI 3,279–4,392), for regimen 2 it was 4,691 mg (95% CI 4,153–5,229), and for regimen 3 it was 3,584 mg (95% CI 3,020–4,148). “These outcomes demonstrate that IV furosemide plus oral metolazone resulted in a significantly higher natriuresis compared to IV furosemide alone,” Dr Abbo observed.

The secondary endpoint of total urinary volume for the 3 regimens was 1.71L (95% CI 1.49–1.93), 1.84L (95% CI 1.63–2.05), and 1.58L (95% CI 1.37–1.80), respectively. Regimen 2 resulted in a significantly higher rate of worsening renal function, but this did not result in a difference in hospital admissions.

“In these chronic patients receiving high-dose IV furosemide and HF guideline-directed medical therapy, including SGLT2 inhibitors, adding IV acetazolamide did not result in better natriuresis or urine volume excretion,” concluded Dr Abbo.

1. 
   
   1. Abbo A, et al. DEA-HF: The heart failure diuresis efficacy comparison study. Late breaking clinical trials: medical therapy, Heart Failure 2024, 11–14 May, Lisbon, Portugal.

Copyright ©2024 Medicom Medical Publishers



Posted on 16 July 202416 July 2024