Acetazolamide therapy in patients with acute heart failure: a systematic review and meta-analysis of randomized controlled trials

Heart Fail Rev. 2024 Sep;29(5):1039-1047. doi: 10.1007/s10741-024-10417-7. Epub 2024 Jul 10.

Abstract

Acute heart failure (AHF) often leads to unfavorable outcomes due to fluid overload. While diuretics are the cornerstone treatment, acetazolamide may enhance diuretic efficiency by reducing sodium reabsorption. We performed a systematic review and meta-analysis on the effects of acetazolamide as an add-on therapy in patients with AHF compared to diuretic therapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCT). A random-effects model was employed to compute mean differences and risk ratios. Statistical analysis was performed using R software. The GRADE approach was used to rate the certainty of the evidence. We included 4 RCTs with 634 patients aged 68 to 81 years. Over a mean follow-up of 3 days to 34 months, acetazolamide significantly increased diuresis (MD 899.2 mL; 95% CI 249.5 to 1549; p < 0.01) and natriuresis (MD 72.44 mmol/L; 95% CI 39.4 to 105.4; p < 0.01) after 48 h of its administration. No association was found between acetazolamide use and WRF (RR 2.4; 95% CI 0.4 to 14.2; p = 0.3) or all-cause mortality (RR 1.2; 95% CI 0.8 to 1.9; p = 0.3). Clinical decongestion was significantly higher in the intervention group (RR 1.35; 95% CI 1.09 to 1.68; p = 0.01). Acetazolamide is an effective add-on therapy in patients with AHF, increasing diuresis, natriuresis, and clinical decongestion, but it was not associated with differences in mortality.

Keywords: Acetazolamide; Acute heart failure; Decongestion; Diuresis; Diuretics; Natriuresis.

Publication types

  • Systematic Review
  • Meta-Analysis
  • Review

MeSH terms

  • Acetazolamide* / therapeutic use
  • Acute Disease
  • Aged
  • Carbonic Anhydrase Inhibitors / therapeutic use
  • Diuretics* / therapeutic use
  • Heart Failure* / drug therapy
  • Heart Failure* / mortality
  • Heart Failure* / physiopathology
  • Humans
  • Randomized Controlled Trials as Topic*
  • Treatment Outcome

Substances

  • Acetazolamide
  • Diuretics
  • Carbonic Anhydrase Inhibitors