Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure
Maria Rosa Costanzo, MD, FACC*,1,*,
Maya E. Guglin, MD, FACC ,
Mitchell T. Saltzberg, MD, FACC*,2,
Mariell L. Jessup, MD, FACC ,
Bradley A. Bart, MD, FACC ,
John R. Teerlink, MD, FACC||,
Brian E. Jaski, MD, FACC¶,
James C. Fang, MD, FACC#,
Erika D. Feller, MD, FACC**,
Garrie J. Haas, MD, FACC,
Allen S. Anderson, MD, FACC,
Michael P. Schollmeyer, DVM,4,
Paul A. Sobotka, MD, FACC,3 for the UNLOAD Trial Investigators
* Midwest Heart Foundation, Lombard, Illinois
John D. Dingell VA Medical Center, Division of Cardiology, Department of Medicine, Wayne State University, Detroit, Michigan
Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
|| San Francisco Veterans Affairs Medical Center/University of California, San Francisco, California
¶ San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California
# Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
** Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, Maryland
Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
Division of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
CHF Solutions, Brooklyn Park, Minnesota
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Figure 1 Primary Efficacy and Safety End Points
(A) Mean weight loss in kilograms; (B) mean dyspnea score (from 1 = markedly worse to 7 = markedly better) at 48 h after randomization in the ultrafiltration (blue circles) and standard-care (red circles) groups; p values are for the comparison between ultrafiltration and standard care. Error bars indicate 95% confidence intervals (CIs). (C) Mean changes from baseline serum creatinine levels at 8, 24, 48, and 72 h after randomization; at discharge; and 10, 30, and 90 days in the ultrafiltration (red bars) and standard-care (blue bars) groups. Error bars indicate 95% CIs. Differences between groups at each time point were evaluated with the Wilcoxon’s rank-sum test; p > 0.05 at all time points for the comparison of mean change in serum creatinine levels between groups.
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Figure 2 Freedom From Heart Failure Rehospitalization
Kaplan-Meier estimate of freedom from rehospitalization for heart failure within 90 days after discharge in the ultrafiltration (red line) and standard care (blue line) groups.
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Figure 3 Hazard Ratios for Heart Failure Rehospitalization According to Selected Baseline Characteristics
Cox proportional hazards analysis estimate of hazard ratios and their 95% confidence intervals (CIs) for rehospitalization owing to heart failure according to selected baseline characteristics of the study patients.
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