Peripheral ultrafiltration for acute decompensated heart failure. Ultrafiltration in decompensated heart failure n engl j med 3 duration of the ultrafiltration intervention. There remains a large unmet need for new therapies in the treatment of hfref. Hospitalizations for acute decompensated heart failure adhf have increased over time, and costs related to hospitalization account for 75% of the total cost of hf care 2.
A clinical study designed by researchers compared the safety and efficacy of diuretic drugs with that of ultrafiltration. Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute. Among all cardiac diseases, congestive heart failure chf is the leading cause of patient rehospitalization. Effectiveness of ultrafiltration in patients with congestive. In these patients, ultrafiltration has been found to. Ultrafiltration fails to show benefit in acute heart failure. Acute decompensated heart failure adhf is the rapid onset of, or change in. Treatment for heart disease is determined by the specific cause. Ultrafiltration for acute decompensated heart failure.
Despite advances in the therapy of heart failure hf, it continues to be the most common reason for hospitalization of patients age 65 years and presents an enormous burden to the healthcare system. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function. Table 1 current pharmacological therapies based on guideline. Ultrafiltration was associated with worsening renal function and more severe adverse events compared with optimum drug therapy in patients with acute decompensated heart failure, worsened renal. Decompensated heart failure is associated with reduced corin. More than half of people with hf have a reduced ejection fraction hfref, also referred to as systolic heart failure, where the heart muscle does not contract effectively, and therefore less oxygenrich blood is pumped out to the body. The role of ultrafiltration in patients with decompensated.
Acute decompensated heart failure heart failure society of america. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. It does not impair the renal function like the use of diuretics but it also does not lead to an. Ultrafiltration for the treatment of congestive heart. Ultrafiltration is generally used for those with decompensated heart failure whose fluid overload is unresponsive to medical management. The new engl and journal of medicine 2 n engl j med t he acute cardiorenal syndrome type 1 is defined as worsening renal function in patients with acute decompensated heart failure. Ultrafiltration therapies for congestive heart failure. Ultrafiltration in decompensated heart failure springerlink. In the united states more than 5 million patients suffer from hf, and more than one million are admitted annually to hospitals for acute decompensated heart failure adhf.
In patients with decompensated heart failure, venous pressure is also elevated, leading to decreased absorption of oral agents and decreased renal blood flow and renal sodium excretion. In the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial 31 n200 uf was associated with better decongestion, but in the larger n2033 cardiorenal rescue in acute decompensated heart failure carresshf trial 32 there was no difference in the achieved decongestion. Background ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. As heart failure progresses, reduced response to diuretics is common. Acute decompensated heart failure adhf is a common and. The initial objective of decompensated heart failure treatment is the. Managing adhf patients is challenging because of the lack of effective treatments that both reduce symptoms and improve clinical outcomes.
As diuretics are thought to contribute to deterioration of. In the united states, more than 1 million patients are admitted annually for acute decompensated heart failure adhf. Peritoneal ultrafiltration in patients with advanced decompensated heart failure article pdf available in journal of nephrology j nephrol26 supl 21. Ultrafiltration therapies for congestive heart failure maria rosa costanzo traditional diuretic therapies for congestion in heart failure patients are simultaneously ineffective and expensive. Heart failure is a complex syndrome that involves both acute and chronic processes. Efficacy and safety of ultrafiltration in decompensated heart failure patients with renal insufficiency. Conventional diuretic therapy of both crs and diuretic. Announces ultrafiltration metaanalysis highlighting significant reduction in heart failure readmissions at 90 days. Among patients hospitalized with fluid overload due to acute decompensated heart failure, mechanical ultrafiltration was associated with greater weight loss by 48 hours, but no difference in dyspnea score compared with diuretic therapy. Summary of the ii brazilian guideline update on acute heart failure. Congestive symptoms from excessive sodium and water retention in adhf are most.
Heart failure hf is a major and growing health problem worldwide and is the leading cause of hospitalization in the western world. Little is known about the efficacy and safety of ultr. Ultrafiltration in acute decompensated heart failure. The ultrafiltration arm of the trial also had the added benefit of less readmission to the hospital for decompensated heart failure. Ultrafiltration in patients with decompensated heart failure. Although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure with acute cardiorenal system type 1, the first clinical trial to test its value shows that it is inferior to standard drug therapy. Ultrafiltration versus intravenous diuretics for patients. The adhere acute decompensated heart failure national. This medical coverage guideline must be read in its entirety to determine coverage eligibility, if any. Thus, the foremost goal in managing acutely decompensated heart failure is to effectively resolve fluid overload.
Ultrafiltration in the management of heart failure. We performed metaanalysis to determine its role in reducing readmissions after acute decompensated heart failure. Fluid status was managed by means of ultrafiltration with the use of the aquadex system 100 chf solutions according to the manufacturers specifications. Acute heart failure european society of cardiology. However, nephrologists think that uf is a treatment method for heart and not for kidney failure. Characteristics and outcomes of patients hospitalized for heart failure in the united states. Nov 06, 2012 although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure with acute cardiorenal. Esc guidelines on the diagnosis and treatment of acute heart failure. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure.
Compared with diuretics, ultrafiltration provides a more predictable and safer way to achieve euvolemia with minimal electrolyte abnormalities and. Peripheral ultrafiltration for acute decompensated heart. We performed metaanalysis to determine its role in reducing readmissions after acute decompensated heart. Pdf peritoneal ultrafiltration in patients with advanced. Heart failure is a disease with high incidence and prevalence in the population. Diuretics and ultrafiltration in acute decompensated heart failure. Significance of ultrafiltration in acute decompensated heart failure remains unclear. Ultrafiltration for the treatment of congestive heart failure. Vassar brothers reduces discomfort for heart failure. This disease can be associated with worsening renal function, a phenomenon called cardiorenal syndrome crs, which is challenging to manage. Clinical policy ultrafiltration for heart failure page 4 of 6 9. Diuretics are the mainstay of therapy for restoring the euvolaemic state in patients with decompensated heart failure.
Based on the pathophysiologic mechanisms, especially in. A conclusion of the trial noted that in patients with decompensated heart failure, ultrafiltration produced greater weight loss and fluid loss than intravenous diuretics. Moreover, many patients with adhf are discharged without clinical evidence of adequate decongestion. Extracorporeal ultrafiltration for fluid overload in heart. They stay one day less than other heart failure patients in the hospital, and they have fewer readmissions. Extracorporeal ultrafiltration for fluid overload in heart failure. Ultrafiltration in decompensated heart failure with. Diuretics and ultrafiltration in acute decompensated heart. Acute decompensated heart failure adhf is one of the leading causes of hospitalization in the united states. Background congestive heart failure chf heart failure hf is a major public health problem in the united states. The aim of the best practice guidelines on peritoneal ultrafiltration uf in patients with treatmentresistant advanced decompensated heart failure trahdf is to achieve a common approach to the management of decompensated heart failure in those situations in which all conventional treatment options have been unsuccessful, and to stimulate a closer cooperation between nephrologists and. Our medical policies are designed for informational purposes only and are not an authorization, explanation of benefits or a contract. Peritoneal ultrafiltration in patients with advanced.
Aetna considers ultrafiltration medically necessary for the acute management of inpatient members hospitalized with acutely decompensated congestive heart failure chf who have dyspnea at rest or with minimal activity, and have confirmed diuretic resistance defined as dose escalation beyond a persons previously recognized dose ceiling or a dose approaching the maximum. We conducted a retrospective cohort study to examine the efficacy and safety of ultrafiltration. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients. Dec, 2012 ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Readmission rate after ultrafiltration in acute decompensated heart failure. In these patients, ultrafiltration has been found to alleviate excess volume and improve diuretic sensitivity. Fluid overload and lung congestion are the major reasons for these recurrent admissions. Ultrafiltration was performed at a fluidremoval rate of 200 ml per hour. Heart failure hf is a major and growing public health problem worldwide with high morbidity, mortality, and cost 1. Extracorporeal ultrafiltration for acute heart failure. Ultrafiltration in patients with decompensated heart. While the costs associated with ultrafiltration during the index hospitalization may exceed those of intravenous diuretics, total cost over time may be lower due to decreased resource utilization for heart failure. Acute heart failure slideset european society of cardiology.
A randomised controlled trial should be conducted to investigate whether the addition of low. The economic impact of ultrafiltration as an initial strategy for decompensated heart failure was also not addressed in this trial. Backgroundby promoting salt and water excretion, the corin and the atrial natriuretic peptide anp system should help to maintain fluid. Congestion and volume overload are the hallmarks of acute decompensated heart failure adhf, and loop diuretics have historically been the cornerstone of treatment. The trial was called the rapidchf study, which stands for relief for acutely fluid overloaded patients with decompensated congestive heart failure. We recommend the diagnosis of acute heart failure be. Diuretics or ultrafiltration for acute decompensated heart. Ultrafiltration in decompensated heart failure n engl j med 367. Peripheral ultrafiltration for acute decompensated heart failure clinical policy bulletins medical clinical policy bulletins number.
Some studies, like the cardiorenal rescue study in acute decompensated heart failure carresshf36 and the aquapheresis versus intravenous diuretics and hospitalization for heart failure avoidhf trials,35 have observed a higher frequency of adverse events in patients treated with ultrafiltration, raising some concerns regarding its safety. Despite therapeutic advances in the care of chronic. Aetna considers ultrafiltration medically necessary for the acute management of inpatient. The negative prognostic impact of worsening renal function in patients with decompensated heart failure has been widely recognised. Readmission rate after ultrafiltration in acute decompensated. Uf is an effective and safe treatment that can improve the health outcomes of asian patients with decompensated heart failure and diuretic resistance. Ultrafiltration in patients with decompensated heart failure and diuretic resistance. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by. Fluid congestion is the hallmark of decompensated heart failure. Three recent studies suggest that failure to adequately reduce fluid excess in patients with acutely decompensated heart failure trumps increases in serum creatinine in predicting poor outcomes. Ultrafiltration versus intravenous diuretics for patients hospitalized for. Vassar brothers reduces discomfort for heart failure patients. All ultrafiltration devices for decompensated heart failure are considered. Major precipitants of decompensation from established hf.
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