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