Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure

Bart, Bradley A.; Boyle, Andrew; Bank, Alan J.; Anand, Inder; Olivari, Maria Teresa; Kraemer, Mark; Mackedanz, Shari; Sobotka, Paul; Schollmeyer, Mike; Goldsmith, Steven R.

doi:10.1016/j.jacc.2005.05.098

Cited by 346 publications

(99 citation statements)

References 14 publications

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“…11,25 This may appear contradictory when compared with both diuretic and ultrafiltration trial results in which an increased diuretic-induced or ultrafiltration-induced volume loss was not accompanied by an improvement in morbidity and mortality. [25][26][27][28][29][30][31][32][33] Several possible explanations may be relevant. First, serial, in fact daily, assessment of filling pressures was made only in the IHM studies.…”

Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Zile

Bennett

Hajj

et al. 2017

Circ: Heart Failure

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Background-The purpose of this analysis was to examine whether implantable hemodynamic monitor-derived baseline estimated pulmonary artery diastolic pressure (ePAD) and change from baseline ePAD were independent predictors of all-cause mortality in patients with chronic heart failure. Methods and Results-Retrospective analysis used data from 3 studies (n=790 patients; 216 deaths). Baseline ePAD was related to mortality using a multivariable model including baseline and demographic data. Changes in ePAD defined as change from baseline to 6 months and from baseline to 14 days before death or exit from study were related to subsequent mortality, and analysis was adjusted for baseline ePAD. Area under the pressure versus time curve during 180 days before death or exit from study was related to mortality. Baseline ePAD, independent of other covariates, was a significant predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.09; P<0.0001). Change in ePAD was an independent predictor of mortality (hazard ratio=1.07; 95% confidence interval=1.05-1.100; P=0.0008). Increased ePAD of 3, 4, or 5 mm Hg from baseline to 6 months was associated with increased mortality risk of 23.8%, 32.9%, or 42.8%. Change in ePAD from baseline to 14 days before death or exit from study was higher in patients who died (3.0±8 versus 1.7±10 mm Hg; P=0.003). Area under the pressure versus time curve in the final 180 days before death or exit from study was higher in patients who died versus those alive at end of study (185±668 versus 17±482 mm Hg.days; P=0.006). Conclusions-Implantable hemodynamic monitor-derived baseline ePAD and change from baseline ePAD were independent predictors of mortality in chronic heart failure patients. (Circ Heart Fail. 2017;10:e003594.

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Section: Pathophysiologic Implications and Results Of Diuretic Trialsmentioning

confidence: 99%

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Zile

Bennett

Hajj

et al. 2017

Circ: Heart Failure

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“…After independent screening for study inclusion, the full manuscripts or conference abstracts of 57 studies were reviewed and 10 were retained for final inclusion in the review. [3][4][5][6][8][9][10][11][12][13][14][15] A C C E P T E D M A N U S C R I P T…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have evaluated the efficacy of extracorporeal ultrafiltration compared to intravenous diuretics among decompensated patients without diuretic resistance and the results are inconsistent. [3][4][5][6] In view of the inconsistent evidence and the emergence of new studies we conducted a systematic review and meta-analysis to determine whether reported trials compared the efficacy of ultrafiltration with diuretics alone and if any patient groups more likely to benefit or be harmed by ultrafiltration compared to diuretics.…”

Section: Introductionmentioning

confidence: 99%

Ultrafiltration for acute decompensated cardiac failure: A systematic review and meta-analysis

Kwok

Wong

Rushton

et al. 2017

International Journal of Cardiology

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“…The first, Relief for Acutely Fluid Overloaded Patients with Decompensated Congestive Heart Failure (RAPID-CHF), was a proof of concept study of 40 patients with ADHF randomized to a single 8 hour period of UF or to usual care [63]. There was no significant difference between UF and usual care for the primary end point of weight loss at 24 hours, but fluid removal after 24 h was significantly greater with UF, with significantly improved dyspnea and HF symptoms at 48 h in the UF group.…”

Section: Ultrafiltrationmentioning

confidence: 99%

The use of diuretics in acute heart failure: Evidence based therapy?

Vazir¹,

Cowie²

2013

WJCD

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The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is firmly established in clinical practice, and endorsed in clinical guidelines. Loop diuretics are typically the first line diuretic strategy for the treatment of acute heart failure. For patients with considerable fluid retention, there is some evidence that initial treatment with continuous infusion or boluses of high dose loop diuretic is superior to an initial lower dose strategy. In patients who are diuretic resistant, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. Intravenous low-dose dopamine has also been used to assist diuresis and preserve renal function in such circumstances, but trials are underway to confirm the clinical value of this agent. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence base is not secure, and its place in clinical practice is yet to be established.

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Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure

Abstract: The early application of UF for patients with CHF was feasible, well-tolerated, and resulted in significant weight loss and fluid removal. A larger trial is underway to determine the relative efficacy of UF versus standard care in acute decompensated heart failure.

Cited by 346 publications

References 14 publications

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Intracardiac Pressures Measured Using an Implantable Hemodynamic Monitor

Ultrafiltration for acute decompensated cardiac failure: A systematic review and meta-analysis

The use of diuretics in acute heart failure: Evidence based therapy?

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