(231) Evaluation of Acetazolamide for Acute Decompensated Heart Failure

Introduction: Acetazolamide is a diuretic that acts on the proximal tubule of the nephron. Previous evidence suggests adding acetazolamide to standard intravenous (IV) loop diuretic therapy could facilitate further decongestion in patients with acute decompensated heart failure (ADHF). The objective of this evaluation was to report institutional use of acetazolamide and compare outcomes of ADHF patients who received adjunctive acetazolamide (AA) versus loop diuretic (LD) monotherapy for acute decongestion.

Methods: This was a single-center, retrospective review of patients admitted to Riverside University Health System between October 1, 2023 and January 20, 2024 who were treated with IV acetazolamide for ADHF. Patients were divided into cohorts of LD monotherapy vs LD + AA combination therapy for the indication of ADHF decongestion. The primary outcome was hospital length of stay (LOS). Safety outcomes were also assessed, including electrolyte derangements, acid-base disturbances, and serum creatinine (sCr) trends.

Results: A sample population of 50 patients was included for analysis (LD+AA n=33 vs LD monotherapy n=17). There was no difference in baseline ejection fraction (LD+AA 31.4% vs LD monotherapy 33.8%). The mean dose of AA was 609mg. Patients in the LD+AA cohort received higher doses of LD therapy compared to the LD monotherapy cohort within the first 24 hours of admission (LD+AA 140mg vs LD monotherapy 81.3mg), but there was no difference in overall LD doses between cohorts for the whole admission. Patients who received LD+AA experienced a more robust urine output within the first 24 hours of admission (LD+AA 3199 mL vs LD monotherapy 2534 mL). There was no observed reduction in hospital LOS between cohorts (LD+AA 5.3 days vs LD monotherapy 4.3 days). Patients treated with AA showed a greater in-hospital increase in sCr compared to those receiving LD monotherapy (LD+AA +0.2 mg/dL vs LD monotherapy +0.01 mg/dL) and no difference in acid-base disturbances throughout the hospital stay.

Conclusions: The use of AA was not associated with a decrease in hospital LOS and patients required higher LD doses with a subsequent greater effect on renal function when compared to LD monotherapy for ADHF decongestion. These findings suggest a need for re-evaluation of AA's utility in this patient population.