Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(8), 853–865. https://doi.org/10.1002/clc.24033 Dr. Carlos Diaz-Arocutipa et al.
Points
- A study conducted until June 2022 assessed the effectiveness of combining hypertonic saline solution (HSS) with furosemide versus using furosemide alone for acute decompensated heart failure (ADHF) patients.
- The analysis of ten randomized controlled trials involving 3013 patients demonstrated that HSS plus furosemide significantly reduced hospital stay length, weight, serum creatinine levels, and type-B natriuretic peptide concentrations compared to furosemide alone.
- Combining HSS and furosemide also increased urine output, serum sodium levels, and urinary sodium excretion.
- Trial sequential analysis (TSA) supported the observed benefits of HSS plus furosemide, confirming its efficacy.
- The study concludes that HSS plus furosemide shows promise in improving surrogate endpoints for ADHF patients. However, further adequately powered randomized controlled trials are required to assess its impact on heart failure readmission and mortality.
Summary
In a recent study conducted until June 30, 2022, the efficacy of hypertonic saline solution (HSS) in combination with furosemide was examined in contrast to furosemide monotherapy for patients experiencing acute decompensated heart failure (ADHF). This investigation encompassed a systematic review of ten randomized controlled trials (RCTs) comprising 3013 patients, with the quality of evidence (QoE) assessed using the GRADE approach. Utilizing a random-effects model, meta-analyses were conducted to evaluate various clinical parameters, while a trial sequential analysis (TSA) was employed to assess intermediate and biomarker outcomes.
The findings revealed that administering HSS and furosemide led to several significant improvements in ADHF patients compared to furosemide alone. Specifically, it resulted in a noteworthy reduction in the length of hospital stay (mean difference [MD]: −3.60 days; 95% confidence interval [CI]: −4.56 to −2.64; QoE: moderate), body weight (MD: −2.34 kg; 95% CI: −3.15 to −1.53; QoE: moderate), serum creatinine levels (MD: −0.41 mg/dL; 95% CI: −0.49 to −0.33; QoE: low), and type-B natriuretic peptide concentrations (MD: −124.26 pg/mL; 95% CI: −207.97 to −40.54; QoE: low). Furthermore, HSS plus furosemide significantly augmented urine output (MD: 528.57 mL/24 h; 95% CI: 431.90 to 625.23; QoE: moderate), serum sodium levels (MD: 6.80 mmol/L; 95% CI: 4.92 to 8.69; QoE: low), and urinary sodium excretion (MD: 54.85 mmol/24 h; 95% CI: 46.31 to 63.38; QoE: moderate) when compared to furosemide alone. The trial sequential analysis (TSA) notably reinforced the observed benefits of the HSS plus furosemide combination.
However, a meta-analysis was not conducted for these specific outcomes due to the heterogeneity in mortality and heart failure readmission. Consequently, the study concludes that HSS, in combination with furosemide, yields improvements in surrogate endpoints among ADHF patients, albeit with moderate to low QoE. The need for adequately powered RCTs to comprehensively evaluate the impact on heart failure readmission and mortality remains an essential future research direction.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24033
References Diaz‐Arocutipa, C., Denegri‐Galvan, J., Vicent, L., Pariona, M., Mamas, M. A., & Hernandez, A. V. (2023). The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta‐analysis and trial sequential analysis. Clinical Cardiology, 46(8), 853–865. https://doi.org/10.1002/clc.24033
