Methodology Score: 4/5
Usefulness Score: 2/5 (Emergency)
                                 4/5 (Internal medicine)

Mullens W, et al. N Engl J Med. 2022 Sep 29;387(13):1185-1195. 

Editorial: New Decongestion Strategies in an Evolving Heart Failure Landscape.

Question and Methods: RCT comparing acetazolamide versus placebo on rate of decongestion using loop diuretics in hospitalized patients with acute decompensated heart failure.
Findings: Higher rate of decongestion with acetazolamide versus placebo [108/256 (42.2%) vs 79/259 (30.5%); RR 1.46 (95% CI 1.17-1.82)] with no increased adverse events.
Limitations: Limited applicability to emergency practice; not generalizable to patients with new heart failure or taking SGLT-2 inhibitors.

Interpretation: Acetazolamide added to loop diuretics may increase rate of decongestion for patients admitted with acute decompensated heart failure, but has limited utility in emergency practice.

Author: Dr. Hashim Kareemi

JC Supervisor: Dr. Jeff Perry




  • Hashim Kareemi

    Dr. Hashim Kareemi is an Emergency Medicine resident at the University of Ottawa.

  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

  • Jeff Perry

    Dr. Perry is an Emergency Physician and full Professor in the department of Epidemiology and Community Medicine. He has a special research interest in subarachnoid hemorrhage, TIA and stroke.