6/28/23, 12:03 AM ADVOR Pathway Feedback Search Clinical Topics Home Studies ADVOR ADVOR Disease Heart failure Trial question What is the role of acetazolamide in patients with acute decompensated HF with volume overload? Study design Multi-center Double blinded RCT Population Characteristics of study participants 37.0% female N = 519 63.0% male 519 patients (194 female, 325 male) Inclusion criteria: patients with acute decompensated HF, clinical signs of volume overload, and N- terminal pro-BNP level > 1,000 pg/mL or BNP level > 250 pg/mL Key exclusion criteria: receipt of acetazolamide maintenance therapy or treatment with another proximal tubular diuretic including a SGLT-2 inhibitor; systolic BP < 90 mmHg; and an eGFR < 20 mL/min/1.73 m Interventions N=259 acetazolamide (intravenous bolus of 500 mg daily plus standardized intravenous loop diuretics) N=260 placebo (matching placebo added to standardized intravenous loop diuretics) https://web.pathway.md/studies/reciUXUeJ5fUR7RTQ 1/2 6/28/23, 12:03 AM ADVOR Pathway Primary outcome Successful decongestion at 3 days 42.2 % 42.2 31.7 % 30.5 21.1 % Significant increase 10.6 % NNT = 9 0.0 % Acetazolamide Placebo Significant increase in successful decongestion at 3 days (42.2% vs. 30.5%; RR 1.46, 95% CI 1.17 to 1.82) Secondary outcomes No significant difference in death from any cause or rehospitalization for HF (29.7% vs. 27.8%; HR 1.07, 95% CI 0.78 to 1.48) Borderline significant decrease in duration of hospital stay (8.8 days vs. 9.9 days; RR 0.89, 95% CI 0.81 to 0.98) No significant difference in death from any cause or rehospitalization for HF at 3 months (29.7% vs. 27.8%; HR 1.07, 95% CI 0.78 to 1.48) Safety outcomes No significant differences in worsening kidney function, hypokalemia, hypotension, and adverse events. Conclusion In patients with acute decompensated HF, clinical signs of volume overload, and N-terminal pro- BNP level > 1,000 pg/mL or BNP level > 250 pg/mL, acetazolamide was superior to placebo with respect to successful decongestion at 3 days. Reference Wilfried Mullens, Jeroen Dauw, Pieter Martens et al. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload. N Engl J Med. 2022 Sep 29;387(13):1185-1195. Open reference URL https://web.pathway.md/studies/reciUXUeJ5fUR7RTQ 2/2