For patients with acute decompensated HF, the addition of acetazolamide to loop diuretic therapy yields an increased incidence of successful decongestion, according to a study published in the New England Journal of Medicine. Frank Ruschitzka, MD, FRCP (Edinburgh), FESC, and colleagues conducted a parallel-group, double blind, randomized, placebo-controlled trial of patients with acute decompensated HF, clinical signs of volume overload, and an N-terminal pro-B-type natriuretic peptide level of more than 1,000 pg/mL or a B-type natriuretic peptide level of more than 250 pg/ mL. They randomly assigned 519 participants to IV acetazolamide or placebo added to standard loop diuretics. Successful decongestion occurred in 42.2% of 256 patients in the acetazolamide group and in 30.5% of 259 patients in the placebo group (risk ratio, 1.46; 95% CI, 1.17-1.82). Death from any cause or rehospitalization for HF occurred in 29.7% and 27.8% of patients in the acetazolamide and placebo groups, respectively (HR, 1.07; 95% CI, 0.78-1.48). Higher cumulative urine output and natriuresis were seen in association with acetazolamide treatment, which was consistent with better diuretic efficiency. “These data suggest the use of acetazolamide as a reasonable adjunct to achieving more rapid decongestion,” the authors of an accompanying editorial wrote.
