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Randomized Controlled Trial
. 2022 Sep;24(9):1601-1610.
doi: 10.1002/ejhf.2587. Epub 2022 Jul 12.

Acetazolamide in Decompensated Heart Failure with Volume Overload trial (ADVOR): baseline characteristics

Wilfried Mullens  1   2 , Jeroen Dauw  1   2 , Pieter Martens  1 , Evelyne Meekers  1   2 , Petra Nijst  1 , Frederik H Verbrugge  3   4 , Fabien Chenot  5 , Samer Moubayed  6 , Riet Dierckx  7 , Philippe Blouard  8 , David Derthoo  9 , Walter Smolders  10 , Bavo Ector  11 , Michaël Hulselmans  12 , Stijn Lochy  3 , David Raes  13 , Emeline Van Craenenbroeck  14   15 , Hans Vandekerckhove  16 , Pieter-Jan Hofkens  17 , Kathleen Goossens  18 , Anne-Catherine Pouleur  19 , Michel De Ceuninck  20 , Laurence Gabriel  21 , Philippe Timmermans  22 , Edgard A Prihadi  23 , Frederik Van Durme  24 , Michel Depauw  25 , Delphine Vervloet  26 , Els Viaene  27 , Jean-Luc Vachiery  28 , Katrien Tartaglia  1 , Jozine M Ter Maaten  29 , Liesbeth Bruckers  2 , Walter Droogne  30 , Pierre Troisfontaines  31 , Kevin Damman  29 , Johan Lassus  32 , Alexandre Mebazaa  33 , Gerasimos Filippatos  34 , Frank Ruschitzka  35 , Matthias Dupont  1
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Free article
Randomized Controlled Trial

Acetazolamide in Decompensated Heart Failure with Volume Overload trial (ADVOR): baseline characteristics

Wilfried Mullens et al. Eur J Heart Fail. 2022 Sep.
Free article

Abstract

Aims: To describe the baseline characteristics of participants in the Acetazolamide in Decompensated Heart Failure with Volume Overload (ADVOR) trial and compare these with other contemporary diuretic trials in acute heart failure (AHF).

Methods and results: ADVOR recruited 519 patients with AHF, clinically evident volume overload, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) and maintenance loop diuretic therapy prior to admission. All participants received standardized loop diuretics and were randomized towards once daily intravenous acetazolamide (500 mg) versus placebo, stratified according to study centre and left ventricular ejection fraction (LVEF) (≤40% vs. >40%). The primary endpoint was successful decongestion assessed by a dedicated score indicating no more than trace oedema and no other signs of congestion after three consecutive days of treatment without need for escalating treatment. Mean age was 78 years, 63% were men, mean LVEF was 43%, and median NT-proBNP 6173 pg/ml. The median clinical congestion score was 4 with an EuroQol-5 dimensions health utility index of 0.6. Patients with LVEF ≤40% were more often male, had more ischaemic heart disease, higher levels of NT-proBNP and less atrial fibrillation. Compared with diuretic trials in AHF, patients enrolled in ADVOR were considerably older with higher NT-proBNP levels, reflecting the real-world clinical situation.

Conclusion: ADVOR is the largest randomized diuretic trial in AHF, investigating acetazolamide to improve decongestion on top of standardized loop diuretics. The elderly enrolled population with poor quality of life provides a good representation of the real-world AHF population. The pragmatic design will provide novel insights in the diuretic treatment of patients with AHF.

Keywords: Acetazolamide; Acute heart failure; Congestion; Diuretics; Randomized controlled trial; Volume overload.

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References

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