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Trullàs JC, Peláez AI, Blázquez J, Sánchez-Biosca A, López-Reborio ML, Salamanca-Bautista P, Fernández-Rodríguez JM, Vázquez-Ronda MÁ, Dávila-Ramos MF, Mendoza-Ruiz-De-Zuazu H, Morales-Rull JL, Olmedo-Llanes J, Llàcer P, Conde-Martel A. The significance of metabolic alkalosis on acute decompensated heart failure: the ALCALOTIC study. Clin Res Cardiol 2024; 113:1251-1262. [PMID: 38709335 DOI: 10.1007/s00392-024-02452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
AIMS To determine the prevalence and the impact on prognosis of metabolic alkalosis (MA) in patients admitted for acute heart failure (AHF). METHODS AND RESULTS The ALCALOTIC is a multicenter, observational cohort study that prospectively included patients admitted for AHF. Patients were classified into four groups according to their acid-base status on admission: acidosis, MA, respiratory alkalosis, and normal pH (reference group for comparison). Primary endpoint was all-cause in-hospital mortality, and secondary endpoints included 30/90-day all-cause mortality, all-cause readmission, and readmission for HF. Associations between endpoints and acid-base alterations were estimated in a multivariate Cox regression model including sex, age, comorbidities, and Barthel index and expressed as hazard ratio (HR) with 95% confidence interval (95% CI). Six hundred sixty-five patients were included (84 years and 57% women), and 40% had acid-base alterations on admission: 188 (28%) acidosis and 78 (12%) alkalosis. The prevalence (95% CI) of MA was 9% (6.8-11.2%). Patients with MA were more women; had fewer comorbidities, better renal function, and higher left ventricle ejection fraction values; and received more treatment with oral acetazolamide during hospitalization and at discharge. MA was not associated with a higher risk of in-hospital mortality and 30/90-day all-cause mortality or readmissions but was associated with a significant increase in readmissions for HF at 30 and 90 days (adjusted HR [95% CI] 3.294 [1.397-7.767], p = 0.006 and 2.314 [1.075-4.978], p = 0.032). CONCLUSION The prevalence of MA in patients admitted for AHF was 9%, and its presence was associated with more readmissions for HF but not with all-cause mortality.
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Affiliation(s)
- Joan Carles Trullàs
- Internal Medicine Department, Hospital d'Olot i Comarcal de La Garrotxa, Girona, Av Dels Països Catalans, 86, Olot, 17800, Girona, Catalonia, Spain.
- Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Carretera de Roda, 70, Vic, 08500, Barcelona, Catalonia, Spain.
| | - Ana Isabel Peláez
- Internal Medicine Department, Hospital Universitario Rafael Méndez, Ctra.N-340, 30813, Lorca, Murcia, Spain
| | - Julio Blázquez
- Internal Medicine Department, Hospital Universitario de Torrevieja, Carretera CV 95, S/N, 03186, Torrevieja, Alicante, Spain
| | - Anna Sánchez-Biosca
- Internal Medicine Department, Fundació Hospital de L'Esperit Sant, Avinguda Mossèn Josep Pons I Rabadà, S/N, Santa Coloma de Gramenet, 08923, Barcelona, Catalonia, Spain
| | - Manuel Lorenzo López-Reborio
- Internal Medicine Department, Hospital Comarcal Monforte de Lemos, Rúa Corredoira, S/N, Monforte de Lemos, 27400, Lugo, Spain
| | - Prado Salamanca-Bautista
- Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Avenida Dr. Fedriani, 3, 41009, Seville, Spain
| | - José María Fernández-Rodríguez
- Internal Medicine Department, Hospital Carmen y Severo Ochoa, Calle Sienra, 11, Cangas del Narcea, 33800, Asturias, Spain
| | - Miguel Ángel Vázquez-Ronda
- Internal Medicine Department, Hospital Universitario Infanta Sofía, P.º de Europa, 34, San Sebastián de los Reyes, 28703, Madrid, Spain
| | - Melitón Francisco Dávila-Ramos
- Internal Medicine Department, Hospital Universitario Nuestra Señora de La Candelaria, Carretera Gerenal del Rosario, 145, 38010, Santa Cruz de Tenerife, Spain
| | | | - José Luís Morales-Rull
- Internal Medicine Department, Heart Failure Unit, Hospital Universitari Arnau de Villanova, Institut de Recerca Biomédica (IRBLleida), Avinguda Alcalde Rovira Roure, 80, 25198, Lleida, Catalonia, Spain
| | - Jesús Olmedo-Llanes
- Internal Medicine Department, Hospital de Antequera, Avenida Poeta Muñoz Rojas, S/N, Málaga, 29200, Antequera, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, M-607, 9, 100, 28034, Madrid, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, C. Pl. Barranco de La Ballena, S/N, 35010, Las Palmas de Gran Canaria, Spain
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Sabina M, Barakat Z, Feliciano A, Lamb A, Alsamman MM. Unlocking the Potential of Acetazolamide: A Literature Review of an Adjunctive Approach in Heart Failure Management. J Clin Med 2024; 13:288. [PMID: 38202295 PMCID: PMC10780103 DOI: 10.3390/jcm13010288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
Background: Heart failure (HF) patients often experience persistent fluid overload despite standard diuretic therapy. The adjunctive use of acetazolamide, a carbonic anhydrase inhibitor, in combination with loop diuretics has shown promise in improving decongestion and diuretic efficacy. This literature review aims to analyze six studies evaluating the effectiveness of acetazolamide as an additive treatment for acute decompensated heart failure (ADHF) and its impact on various outcomes. Methods: We searched the PubMed database using the terms "acetazolamide heart failure". We refined our search with specific filters (as shown our PRISMA flow diagram) and exclusion criteria, narrowing down our results to five studies. We included an extra study via expert recommendation, ultimately including six studies for comprehensive analysis. Results: The review highlights the positive effects of acetazolamide on decongestion, natriuresis, and diuresis in HF patients. However, it also showcases the limitations of these trials. Discussion: While the reviewed studies demonstrate the potential benefits of acetazolamide in enhancing decongestion and diuretic efficiency, there are limitations to consider, including small sample sizes, lack of blinding, and limited external validity. Further research is needed to confirm these findings, compare acetazolamide with other diuretic combinations, and explore its effects in a broader population of heart failure patients, including those in the United States. The use of acetazolamide in HF management warrants continued investigation to optimize its role in improving decongestion and patient outcomes.
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Affiliation(s)
- Michael Sabina
- Lakeland Regional Health Medical Center, Lakeland 33805-4500, FL, USA; (Z.B.); (A.F.); (A.L.); (M.M.A.)
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