Treating Acute Volume Overload of Heart Failure with Acetazolamide

Clinical guidelines recommend intravenous loop diuretics as first-line therapy for volume overload in acute decompensated heart failure; however, even in high doses, these agents alone may be inadequate to achieve timely decongestion. In this randomized, placebo-controlled, double-blind trial, researchers evaluated whether adding the carbonic anhydrase inhibitor acetazolamide to loop diuretics helps achieve successful decongestion (NCT03505788).

The study included 519 individuals (mean age, 78 years; 37% women; 99% White; 43% with reduced left ventricular ejection fraction) hospitalized for acute decompensated heart failure with at least one clinical sign of volume overload and elevated natriuretic peptide levels. All had previously received…