Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure

Griffin, Matthew; Soufer, Aaron; Goljo, Erden; Colna, Matthew; Rao, Veena S.; Jeon, Sangchoon; Raghavendra, P.; D’Ambrosi, Julie; Riello, Ralph; Coca, Steven G.; Mahoney, Devin; Jacoby, Daniel; Ahmad, Tariq; Chen, Michael; Tang, W.H. Wilson; Turner, Jeffrey M.; Mullens, Wilfried; Wilson, F. Perry; Testani, Jeffrey M.

doi:10.1016/j.jchf.2019.10.012

Cited by 76 publications

(64 citation statements)

References 32 publications

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“…Hypertonic saline (HS) increases diuresis and may improve outcome when given alongside intravenous furosemide in patients admitted with HF [ 60 , 61 ]. However, data on changes in chloride levels are absent from almost all reports of HS and whether any observed benefit is due a change in chloride levels is pure speculation.…”

Section: A Therapeutic Target?mentioning

confidence: 99%

Hypochloraemia in Patients with Heart Failure: Causes and Consequences

2020

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Hypochloraemia is a common electrolyte abnormality in patients with heart failure (HF). It has a strong association with adverse outcome regardless of HF phenotype and independent of other prognostic markers. How hypochloraemia develops in a patient with HF and how it might influence outcome are not clear, and in this review we explore the possible mechanisms. Patients with HF and hypochloraemia almost invariably take higher doses of loop diuretic than patients with normal chloride levels. However, renal chloride and bicarbonate homeostasis are closely linked, and the latter may be influenced by neurohormonal activation: it is likely that the etiology of hypochloraemia in patients with HF is multifactorial and due to more than just diuretic-induced urinary losses. There are multiple proposed mechanisms by which low chloride concentrations may lead to an adverse outcome in patients with HF: by increasing renin release; by a stimulatory effect on the with-no-lysine kinases which might increase renal sodium-chloride co-transporter activity; and by an adverse effect on myocardial conduction and contractility. None of these proposed mechanisms are proven in humans with HF. However, if true, it might suggest that hypochloraemia is a therapeutic target that might be amenable to treatment with acetazolamide or chloride supplementation.

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Section: A Therapeutic Target?mentioning

confidence: 99%

Hypochloraemia in Patients with Heart Failure: Causes and Consequences

2020

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“…They are usually “clean” areas that also permit parenteral administration of diuretics. Therefore, methods allowing for a more intense depletion should be chosen, such as hypertonic saline perfusion with furosemide, which safely achieves a greater volume of diuresis in less time, 14 or elastomeric pumps, which allow for continual parenteral infusion for 5 to 7 days. 15 These approaches mean that the patient is not obliged to return to the hospital on successive days.…”

Section: Telemedicine Consultation In Patients With Heart Failurementioning

confidence: 99%

Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology

Barrios

Cosı́n-Sales

Bravo

et al. 2020

Revista Española de Cardiología (English Edition)

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The coronavirus disease 2019 (COVID-19) pandemic has changed how we view our consultations. To reduce the risk of spread in the most vulnerable patients (those with heart disease) and health personnel, most face-to-face consultations have been replaced by telemedicine consultations. Although this change has been rapidly introduced, it will most likely become a permanent feature of clinical practice. Nevertheless, there remain serious doubts about organizational and legal issues, as well as the possibilities for improvement etc. In this consensus document of the Spanish Society of Cardiology, we attempt to provide some keys to improve the quality of care in this new way of working, reviewing the most frequent heart diseases attended in the cardiology outpatient clinic and proposing some minimal conditions for this health care process. These heart diseases are ischemic heart disease, heart failure, and arrhythmias. In these 3 scenarios, we attempt to clarify the basic issues that must be checked during the telephone interview, describe the patients who should attend in person, and identify the criteria to refer patients for follow-up in primary care. This document also describes some improvements that can be introduced in telemedicine consultations to improve patient care.

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“…16,28,29 In contrast, several lines of evidence have suggested an equivalent or even superior diuretic response in patients with HF receiving higher sodium chloride intake. [30][31][32][33] Similarly, a loop diuretic infusion should unequivocally provide a profound advantage over bolus dosing based on traditional DR paradigms. 34,35 However, multiple clinical trials have failed to demonstrate a meaningful difference between bolus and continuous infusion in ADHF.…”

Section: Introductionmentioning

confidence: 99%

“…In normal subjects, the negative sodium balance from a loop diuretic can be completely eliminated by a high‐sodium intake 16,28,29 . In contrast, several lines of evidence have suggested an equivalent or even superior diuretic response in patients with HF receiving higher sodium chloride intake 30–33 . Similarly, a loop diuretic infusion should unequivocally provide a profound advantage over bolus dosing based on traditional DR paradigms 34,35 .…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of Diuretic Resistance Study: design and rationale

et al. 2020

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Introduction Diuretic resistance is a common complication impairing decongestion during hospitalization for acute decompensated heart failure (ADHF). The current understanding of diuretic resistance mechanisms in ADHF is based upon extrapolations from other disease states and healthy volunteers. However, accumulating evidence suggests that the dominant mechanisms in other populations have limited influence on diuretic response in ADHF. Additionally, the ability to rapidly and reliably diagnose diuretic resistance is inadequate using currently available tools. Aims The Mechanisms of Diuretic Resistance (MDR) Study is designed to rigorously investigate the mechanisms of diuretic resistance and develop tools to rapidly predict diuretic response in a prospective cohort hospitalized with ADHF. Methods Study assessments occur serially during the ADHF hospitalization and after discharge. Each assessment includes a supervised 6-hour urine collection with baseline blood and timed spot urine collections following loop diuretic administration. Patient characteristics, medications, physical exam findings, and both in-hospital and post-discharge HF outcomes are collected. Patients with diuretic resistance are eligible for a randomized sub-study comparing an increased loop diuretic dose with combination diuretic therapy of loop diuretic plus chlorothiazide. Conclusions The Mechanisms of Diuretic Resistance Study will establish a prospective patient cohort and biorepository to investigate the mechanisms of diuretic resistance and urine biomarkers to rapidly predict loop diuretic resistance.

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Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure

Cited by 76 publications

References 32 publications

Hypochloraemia in Patients with Heart Failure: Causes and Consequences

Hypochloraemia in Patients with Heart Failure: Causes and Consequences

Telemedicine consultation for the clinical cardiologists in the era of COVID-19: present and future. Consensus document of the Spanish Society of Cardiology

Mechanisms of Diuretic Resistance Study: design and rationale

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