Ultrafiltration Shown Superior to Diuretics in Patients With Severe Heart Failure: Presented at HFSA

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Title: Ultrafiltration Shown Superior to Diuretics in Patients With Severe Heart Failure: Presented at HFSA
URL: http://www.pslgroup.com/dg/22DE9E.htm
Doctor's Guide
September 30, 2008

By Jill Stein

TORONTO -- September 24, 2008 -- Early ultrafiltration can be performed safely in patients with advanced heart failure who experience volume overload, investigators reported at the 12th Annual Scientific Meeting of the Heart Failure Society of America (HFSA).

Ultrafiltration is also associated with a faster removal rate of volume compared with usual care with diuretics and results in a shorter hospital stay without compromising renal function.

Mazen Hanna, MD, Cleveland Clinic, Cleveland, Ohio, and associates randomised 36 patients with advanced heart failure to ultrafiltration (n = 17) or usual care with diuretic therapy (n = 19).

The trial included acutely decompensated patients with an ejection fraction >40% who had been referred to a heart failure intensive care unit (ICU) for a pulmonary artery catheter and "tailored therapy" and whose pulmonary capillary wedge pressure (PCWP) was at least 20 mm Hg.

"While ultrafiltration may promote greater weight loss, a shorter hospital stay, and a reduction in rehospitalisation compared to diuretic therapy, most studies to date have been conducted in patients with moderate heart failure without haemodynamic monitoring," Dr. Hanna pointed out here at a poster session on September 22.

The primary endpoint in this study was the time needed for the PCWP to be maintained at a value of =<18 mm Hg for at least 4 consecutive hours.

Hospital readmission rates and survival were followed for 90 days.

The study documented a trend towards less time needed for the PCWP to be maintained at a value of =<18 mm Hg (19.5 +- 15.09 hours in the ultrafiltration group versus 32.0 +- 25.87 hours in the usual-care group, P = .0837).

The total volume removed during the intervention period was 5,213 +- 3,406.2 mL in the ultrafiltration group and 2,167 +- 2,380.5 mL in the usual-care group.

The weight loss in the ultrafiltration group was slightly more than twice that recorded in the usual-care group.

The length of ICU stay did not differ between the two groups; however, there was a significantly shorter hospital stay in the ultrafiltration group even after adjusting for two outliers in the usual-care group who waited for transplant (mean of 6.98 +- 4.81 days in hospital in the ultrafiltration group versus 18.9 +- 18.9 days for the usual-care group, P = .0008).

The ultrafiltration and usual-care groups did not differ in terms of quality of life or rehospitalisation rate.

Dr. Hanna cautioned that the results may be limited by the small sample size and the fact that diuretic and vasodilator/inotrope management were left to the discretion of the managing physician.

"Ultrafiltration is a safe and effective therapy for acutely decompensated heart failure patients with volume overload and may lead to a shorter hospital stay, which may have significant financial implications in this ever-growing disease burden," the researchers concluded.

Future studies can help clarify issues related to patient selection and the timing of treatment initiation.

[Presentation title: Extracorporeal Ultrafiltration (UF) Versus Usual and Customary Care for Patients With Severe Heart Failure. Abstract 212]

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