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CLINICAL RESEARCH: HEART FAILURE

Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure

The Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) Trial

Bradley A. Bart, MD, FACC^_*,_*, Andrew Boyle, MD^_*, Alan J. Bank, MD, FACC^_*, Inder Anand, MD, FACC^_*, Maria Teresa Olivari, MD, FACC^_*, Mark Kraemer, MD^_*, Shari Mackedanz, RN, BSN, CCRC^_*, Paul A. Sobotka, MD, FACC, Mike Schollmeyer, DVM and Steven R. Goldsmith, MD, FACC^_*

^_* Minnesota Heart Failure Consortium, Minneapolis, Minnesota
CHF Solutions Inc., Brooklyn Park, Minnesota

Manuscript received February 15, 2005; revised manuscript received May 23, 2005, accepted May 31, 2005.

^_* Reprint requests and correspondence: Dr. Bradley A. Bart, O5 HCMC, 701 Park Avenue South, Minneapolis, Minnesota 55415 (Email: bartx006{at}umn.edu).

OBJECTIVES: The purpose of this research was to assess the safety and efficacy of ultrafiltration (UF) in patients admitted with decompensated congestive heart failure (CHF).

BACKGROUND: Ultrafiltration for CHF is usually reserved for patients with renal failure or those unresponsive to pharmacologic management. We performed a randomized trial of UF versus usual medical care using a simple UF device that does not require special monitoring or central intravenous access.

METHODS: Patients admitted for CHF with evidence of volume overload were randomized to a single, 8 h UF session in addition to usual care or usual care alone. The primary end point was weight loss 24 h after the time of enrollment.

RESULTS: Forty patients were enrolled (20 UF, 20 usual care). Ultrafiltration was successful in 18 of the 20 patients in the UF group. Fluid removal after 24 h was 4,650 ml and 2,838 ml in the UF and usual care groups, respectively (p = 0.001). Weight loss after 24 h, the primary end point, was 2.5 kg and 1.86 kg in the UF and usual care groups, respectively (p = 0.240). Patients tolerated UF well.

CONCLUSIONS: The early application of UF for patients with CHF was feasible, well-tolerated, and resulted in significant weight loss and fluid removal. A larger trial is underway to determine the relative efficacy of UF versus standard care in acute decompensated heart failure.

Abbreviations and Acronyms   CHF = congestive heart failure   IV = intravenous   UF = ultrafiltration

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