{"id":138100,"date":"2023-08-30T08:24:30","date_gmt":"2023-08-30T12:24:30","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138100"},"modified":"2023-08-30T08:24:30","modified_gmt":"2023-08-30T12:24:30","slug":"push-ahf-natriuresis-guided-diuresis-approach-increases-natriuresis-and-diuresis-without-improving-all-cause-mortality-or-hf-hospitalization","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138100","title":{"rendered":"PUSH-AHF: Natriuresis-guided diuresis approach increases natriuresis and diuresis without improving all-cause mortality or HF hospitalization"},"content":{"rendered":"<p>Key Points:<\/p>\n<ul>\n<li>Diuretic requirement Is a major contributor to hospital length-of-stay for HF admissions, but the optimal strategy of diuretic optimization has not yet been established. Spot urinary sodium measurement and subsequent natriuresis-guided diuretic adjustment may refine diuretic dosage in the setting of insufficient diuretic response.<\/li>\n<li>In the PUSH-AHF study, natriuresis-guided therapy was compared with standard of care in patients hospitalized with acute HF. The two primary endpoints were a) natriuresis over 24 hours and b) first occurrence of all-cause mortality or heart failure rehospitalization after 180 days.<\/li>\n<li>Natriuresis-guided therapy resulted in significantly increased natriuresis over 24 hours without a significant difference in time to all-cause mortality or heart failure rehospitalization.<\/li>\n<\/ul>\n<p>The duration of acute HF hospitalization is often driven by diuresis requirement, but the optimal strategy of in-hospital diuresis has not yet been established. For those with insufficient diuretic response, assessment of urinary sodium may help monitor diuretic response and guide further therapy. In a breaking presentation at the 2023 ESC Congress today, <a href=\"https:\/\/www.groningencardiology.com\/people\/jozine-ter-maaten\/\">Dr. Jozine ter Maaten (University Medical Centre Groningen )<\/a> and her team presented their study: \u201cPUSH-AHF: Natriuresis guided therapy in acute heart failure.\u201d<\/p>\n<p>The PUSH-AHF trial (<a href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT04606927\">NCT04606927<\/a>) was a randomized, open-label single-center trial of adult patients with a primary inpatient diagnosis of acute heart failure with an intravenous diuretic requirement that compared natriuresis-guided therapy with standard of care diuresis. Natriuresis-guided therapy was dictated by spot urinary sodium measurements; a spot sodium &lt;70 mmol\/L indicated insufficient response and resulted in diuretic therapy adjustment. \u00a0Key exclusion criteria were non-cardiac dyspnea or severe renal impairment requiring dialysis. The two primary outcomes were total natriuresis after 24 hours and first occurrence of all-cause mortality or heart failure rehospitalization after 180 days.<\/p>\n<p>A total of 310 patients were 1:1 randomized to either natriuresis-guided therapy or standard of care. The median age was 74, and 45% were women. Participants receiving natriuresis-guided therapy had a significant increase in natriuresis at 24 hours (409\u00b1178 vs 345\u00b1202 mmol, p=0.0061).\u00a0 However, there were no significant differences in time to all-cause mortality or heart failure rehospitalization after 180 days (HR 0.92, 95% CI 0.62-1.38, p=0.698). The secondary endpoints of 48-hour natriuresis and both 24- and 48-hour diuresis were all increased in the intervention arm (all p&lt;0.02). There was no difference in hospital length-of-stay between the two groups. Natriuresis-guided therapy was safe and well-tolerated.<\/p>\n<p>When discussing the clinical implications of the study at the ESC Congress press conference, Dr. ter Maaten stated: \u201cThe results of the PUSH-AHF trial are directly implementable to improve decongestive treatment as spot urinary sodium values are easy to obtain, inexpensive and widely available\u2026natriuresis guided therapy was safe and is a first step to a personalized treatment approach in patients with acute heart failure.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Diuretic requirement Is a major contributor to hospital length-of-stay for HF admissions, but the optimal strategy of diuretic optimization has not yet been established. Spot urinary sodium measurement and subsequent natriuresis-guided diuretic adjustment may refine diuretic dosage in the setting of insufficient diuretic response. In the PUSH-AHF study, natriuresis-guided therapy was compared with [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138101,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[881,8],"tags":[45,882,47],"ppma_author":[1029],"class_list":{"0":"post-138100","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-esc-2023","8":"category-news","9":"tag-conference","10":"tag-esc-2023","11":"tag-featured","12":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138100","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138100"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138100\/revisions"}],"predecessor-version":[{"id":138102,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138100\/revisions\/138102"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138101"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138100"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}