Adaptation and Applicability of a Diuretic Algorithm for Patients with Heart Failure

Feijó, Maria Karolina Echer Ferreira; Biolo, Andréia; Rabelo‐Silva, Eneida Rejane

doi:10.5935/abc.20130089

Cited by 3 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Total scores range from 1 to 22. Scores ≥5 were found to be associated with congestion in a study of the clinical applicability of the AAD [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Diuretic Treatment Algorithm (DTA) was demonstrated to be effective in preventing HF decompensation, significantly reducing 30-day readmission rates and decreasing HF-related hospitalizations by 50% [ 13 ]. The DTA was later translated and adapted for use in Brazil as the Algoritmo de Ajuste de Diurético (Diuretic Adjustment Algorithm, AAD) and validated in an outpatient sample [ 14 ]. The results of that study demonstrated the feasibility and applicability of the AAD in the Brazilian healthcare reality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial

Feijó

Biolo

Ruschel

et al. 2015

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundOne of the challenges in treating patients with heart failure (HF) is achieving clinical stability and reducing the hospital readmission rate. A diuretic dose adjustment algorithm developed in the United States (Diuretic Treatment Algorithm, DTA) and later validated for use in Brazil (as the Algoritmo de Ajuste de Diurético, AAD) has proved feasible and readily applicable, but its effect on clinical outcomes has yet to be assessed. This report aims to describe a randomized clinical trial protocol designed to assess the effectiveness of the AAD and of nonpharmacologic management in improving clinical stability and reducing the readmission rate at 90 days in patients with HF.Methods/DesignA PROBE (prospective randomized open blinded endpoint) parallel-group design will be used. Adult patients with a diagnosis of reduced ejection fraction HF, who are being treated at a specialized HF clinic are being recruited. Those with indications for loop diuretic dose adjustment during routine clinic visits will be randomized to take part in the trial. Participants in the intervention group (IG) shall have their diuretic doses adjusted in accordance with the AAD and receive four telephone calls (one per week) over 30 days to reinforce guidance on nonpharmacological management (fluid and sodium restriction). Participants in the control group (CG) shall have their diuretic doses adjusted by a physician during the first trial visit and shall not receive any telephone calls. Patients in both groups shall return at 1 month for face-to-face reassessment. The study endpoints shall comprise readmission and/or emergency department visits due to HF decompensation within 90 days and clinical instability. All participants shall be required to have a scale at home (or easy access to one), a telephone number, agree to telephone-based follow-up, and be available to return for a 1-month trial visit. Overall, 135 patients are expected to be enrolled in each group.DiscussionThis trial shall assess the effectiveness of the AAD algorithm and non-pharmacologic management by early identification of clinical deterioration and establishment of a combined intervention to reduce emergency department visits, readmission rate, or a composite endpoint thereof.Trial registration numberClinicalTrials.gov Identifier, NCT02068937 (23 February 2014).

show abstract

“…Total scores range from 1 to 22. Scores ≥5 were found to be associated with congestion in a study of the clinical applicability of the AAD [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial

Feijó

Biolo

Ruschel

et al. 2015

Trials

Self Cite

View full text Add to dashboard Cite

show abstract

“…Limited published algorithms on fluid-volume management exist in the literature and are primarily for the care of patients with left heart failure [42]. While diversity exists among available algorithms in managing heart failure, they are similar to the goal of reducing symptoms of heart failure and preventing hospitalization with optimized outpatient management.…”

Section: Outpatient Scenarios and Illustration Of Fluid-volume Managementioning

confidence: 99%

Volume Management in Pulmonary Arterial Hypertension Patients: An Expert Pulmonary Hypertension Clinician Perspective

et al. 2018

View full text Add to dashboard Cite

Fluid volume management in patients with pulmonary arterial hypertension (PAH) is essential in preventing right ventricular failure. Volume overload may be caused by disease progression, indiscretion of dietary sodium and fluid intake, or medication side effects, and is a frequent complication in patients with PAH. Healthcare professionals (HCPs) who care for patients with PAH have a key role in monitoring, preventing, and managing volume overload. Volume management techniques in patients with PAH include managing diuretic use and electrolyte imbalances, and monitoring fluid retention that can occur from the use of endothelin receptor antagonists or calcium channel blockers. Healthcare providers can create volume management protocols as well as patient educational materials. Patients should be educated to self-monitor their daily weights, incorporate dietary restrictions, and recognize symptoms associated with volume overload. Tools to help HCPs with volume management in patients with PAH are provided in this article.Funding Actelion Pharmaceuticals US, Inc.

show abstract

“…18 This algorithm was validated for use in Brazil, showing a greater reduction in the signs of congestion and body weight than conventional management. 19 However, its effectiveness in reducing readmissions remains unknown in low- to middle-income settings. 19…”

Section: Introductionmentioning

confidence: 99%

“…19 However, its effectiveness in reducing readmissions remains unknown in low- to middle-income settings. 19…”

Section: Introductionmentioning

confidence: 99%

Effects of a diuretic adjustment algorithm protocol on heart failure admissions: A randomized clinical trial

Feijó

Ruschel²,

Bernardes

et al. 2021

J Telemed Telecare

Self Cite

View full text Add to dashboard Cite

Introduction The aim of this study was to evaluate the effectiveness of a diuretic adjustment algorithm (DAA) in maintaining clinical stability and reducing HF readmissions using telemonitoring Technologies. Methods Randomized clinical trial of patients with an indication for furosemide dose adjustment during routine outpatient visits. In the intervention group (IG), the diuretic dose was adjusted according to the DAA and the patients received telephone calls for 30 days. In the control group (CG), the diuretic dose was adjusted by a physician at baseline only. Co-primary outcomes were hospital readmission and/or emergency department visits due to decompensated HF within 90 days, and a 2-point change in the Clinical Congestion Score and/or a deterioration in New York Heart Association functional class within 30 days. Results A total of 206 patients were included. Most patients were male ( n=119; 58%), with a mean age of 62 (SD 13) years. Four patients (2%) in the IG and 14 (7%) in the CG were hospitalized for HF (odds ratio (OR) 0.31 (0.10–0.91); p=0.04). Multivariate analysis showed a reduction of 67% in readmissions and/or emergency department visits due to decompensated HF in the IG compared with the CG (95% CI 0.13–0.88; p=0.027). Regarding the combined outcome of HF readmission and/or emergency department visits or clinical instability, the IG had 20% fewer events than the CG within 30 days (IG: n=48 (23%), CG: n=70 (34%); OR 0.80 (0.63–0.93); p=0.03). Discussion Using DAA improved the combined outcome in these outpatients, with favorable and significant results that included a reduction in HF admissions and in clinical instability. (NCT02068937)

show abstract

Adaptation and Applicability of a Diuretic Algorithm for Patients with Heart Failure

Abstract: The AAD proved applicable in clinical practice after adaption and appears to result in better congestion management in patients with heart failure. The clinical effectiveness of the tool should be tested in a larger patient sample aiming at validating the instrument for Brazil.

Cited by 3 publications

References 11 publications

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial

Effect of a diuretic adjustment algorithm and nonpharmacologic management in patients with heart failure: study protocol for a randomized controlled trial

Volume Management in Pulmonary Arterial Hypertension Patients: An Expert Pulmonary Hypertension Clinician Perspective

Effects of a diuretic adjustment algorithm protocol on heart failure admissions: A randomized clinical trial

Contact Info

Product

Resources

About