- Question
- Does adding acetazolamide to loop diuretics improve decongestion in patients with acute decompensated heart failure and volume overload?
- Design
- Multicenter, parallel-group, double-blind, randomized, placebo-controlled trial of 519 patients. Randomization was stratified by left ventricular ejection fraction (≤40% or >40%), and follow-up was 3 months.
- Population
- Patients with acute decompensated heart failure, clinical signs of volume overload (edema, pleural effusion, or ascites), and NT-proBNP >1000 pg/mL or BNP >250 pg/mL.
- Intervention
- Intravenous acetazolamide 500 mg once daily added to standardized intravenous loop diuretics (a dose equivalent to twice the oral maintenance dose).
- Control
- Intravenous placebo added to the same standardized intravenous loop diuretics.
- Primary outcome
- Successful decongestion, defined as absence of signs of volume overload within 3 days of randomization and without an indication to escalate decongestive therapy.
- Results
- Successful decongestion occurred in 108 of 256 patients (42.2%) with acetazolamide and 79 of 259 (30.5%) with placebo (RR 1.46; 95% CI 1.17 to 1.82; P<0.001). Death from any cause or heart failure rehospitalization occurred in 29.7% with acetazolamide and 27.8% with placebo (HR 1.07; 95% CI 0.78 to 1.48).
- Safety
- The incidence of worsening kidney function, hypokalemia, hypotension, and adverse events was similar in both groups. Acetazolamide was associated with higher cumulative urine output and natriuresis.
- Conclusion
- Adding acetazolamide to loop diuretic therapy increased the incidence of successful decongestion in acute decompensated heart failure with volume overload.
- Why it matters
- It provided evidence that boosting loop diuretic action with a carbonic anhydrase inhibitor allows more effective decongestion during hospitalization, without evidence of an effect on longer-term clinical events.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026