Feasibility and efficacy of acetazolamide in the treatment of acute decompensated heart failure

Abstract Background The ADOVAR trial showed that the addition of acetazolamide to loop diuretics could be expected to result in more rapid diuresis and shorter hospital stays in patients with acute decompensated heart failure (ADHF). However, tolvaptan and SGLTII inhibitors are often added for patients with ADHF in Japan. Method An inception cohort of patients with ADHF admitted between January 2022 and June 2023 was assessed. We studied baseline characteristics and divided the patients into "acetazolamide-use" and "no-use" groups. After three days of admission, the endpoint was the reduction rate of body weight, urine output, and the Congestion Score Index (CSI) improvement rate. Results A total of 222 patients were included (73 of the use group and 149 of the no-use group). Baseline characteristics showed the use of catecholamines, PDE III inhibitors, and SGLTII inhibitors were higher in the use group (30.1% vs. 14.8%; P<0.05, 37.0% vs. 8.1%; P<0.05, and 75.3% vs. 38.3%; P<0.05). The reduction rate of body weight, the amount of urine output, and the CSI improvement rate were higher in the use group (6.5% vs. 4.1%; P<0.05, 2745.8ml/day vs. 2004.8ml/day; P<0.05, and 27.8% vs. 19.2%; P<0.05). A hierarchical multiple regression analysis showed the use of acetazolamide and SGLT II inhibitors were the factors that contributed to the reduction of body weight, the amount of urine output, and the improvement of the CSI (P<0.05). Conclusion The addition of acetazolamide to daily medical therapy in patients with ADHF in Japan resulted in a greater incidence of successful decongestion.