Protocolized Diuretic Therapy Compared to Standard Care in Emergency Department Patients With Acute Heart Failure

• Status: Not yet recruiting
• Trial end date: 2026-12-31
• Target enrollment: 0
• Participant gender: All

Summary

This is a randomized trial of protocolized diuretic therapy guided by urinary sodium compared to structured usual care in ED patients with AHF. Participants will be recruited following an initial standard evaluation in the ED and randomized in a 1:1 fashion to structured usual care or protocolized diuretic therapy guided by urinary sodium.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Vanderbilt University Medical Center
• Treatments: Diuretics

Criteria

Inclusion Criteria:

• Age > 18

• Emergency Department diagnosis of Acute Heart Failure (AHF)

• Any one of the following:

i. Chest radiograph or lung ultrasound consistent with AHF ii. Jugular venous distension iii. Pulmonary rales on auscultation iv. Lower extremity edema v. S3 gallop

• > 10 pounds of volume overload physician estimate or historical dry weight

• IV diuretic ordered or planned to be during first 24 hours of ED or inpatient stay

Exclusion Criteria:

• End Stage Renal Disease (ESRD) requiring dialysis

• Need for immediate intubation

• Acute Coronary Syndrome - presentation consistent with myocardial ischemia AND new ST-Segment elevation/depression

• Temperature > 100.5ºF

• End Stage Heart Failure: transplant list or ventricular assist device

• Systolic Blood Pressure < 90 mmHg at time of consent

• LV outflow obstruction, severe uncorrected stenotic valvular disease or severe restrictive cardiomyopathy

• Greater than 2 doses of IV diuretic administered

• Lack of informed consent