Ultrafiltration for acute decompensated HF reduced hospital readmission by 1.74 visits in the following 12 months compared with the prior year, according to data presented at the virtual Heart Failure Society of America Scientific Meeting.
“Utilization of ultrafiltration can improve HF outcomes in selected patients,” Robert A. Watson III, MD, chief of cardiology at Abington Hospital – Jefferson Health in Abington, Pennsylvania, told Healio. “When we can remove fluid and adequately decongest heart failure patients, we can do so safely while protecting renal function, reducing HF rehospitalizations and the subsequent financial burden that accompanies rehospitalizations. Most importantly, we can improve quality of life for HF patients.
“Ultrafiltration isn’t a novel therapy,” Watson said in an interview. “It has been a trusted tool of ours for over a decade. What we have demonstrated is the importance of using this therapy strategically. With consideration of patients’ clinical characteristics, timing of ultrafiltration, and adjustable ultrafiltration rate strategies, we were able to significantly impact and optimize the delivery of standard of care.”
For the single-center, real-word analysis, investigators evaluated the 10-year data of 335 patients (mean age, 73 years; 57% men) who underwent ultrafiltration (Aquadex SmartFlow, CHF Solutions) during hospitalization for acute decompensated HF. The investigators compared their real-world findings with those of the AVOID, CARRESS, DOSE and UNLOAD randomized controlled trials.
At baseline, mean creatinine was 1.78 mg/dL and patients experienced an average of 2.14 HF hospitalizations in the year before ultrafiltration initiation.
After ultrafiltration for acute decompensated HF, the 30-day rehospitalization rate was 12.5%, the 90-day rehospitalization rate was 14.86% and the 1-year rehospitalization rate was 27.27%, translating to an average of 1.74 fewer HF rehospitalizations in the 12 months after therapy initiation compared with the 12 months before initiation.
“These findings were realized despite a patient population that was older, had greater renal dysfunction and included a sicker cohort with advanced cardiac and comorbid conditions than previous ultrafiltration randomized controlled trial studies,” Watson told Healio. “Utilization of adjustable ultrafiltration rates in a healthier population would likely produce even better results than we demonstrated in our more high-risk population. Aquadex therapy is a very flexible system, and we attribute the ability to adjust the amount of fluid removal based on specific patient characteristics as a key contributor for improved outcomes for our patients. Patients are all unique, and their treatment approach should be too. This key point is driven home here through one of the largest and longest heart failure studies based on real-world experience.”
After ultrafiltration therapy, investigators observed:
- mean fluid removal of 14.58 L;
- mean weight loss upon therapy cessation of 15.63 lb., sustained at 1 to 2 weeks follow-up;
- mean change in creatinine upon therapy cessation (0.11 mg/dL), at discharge (0.07 mg/dL) and an average of 30 days follow-up (0.11 mg/dL); and
- major bleeding requiring discontinuation of anticoagulation in 3.6% of patients.
“We would like to reiterate to other providers who may be utilizing ultrafiltration or thinking of doing so, that diuretics should remain a front-line therapy for removing excess fluid,” Watson said in an interview. “For patients who are refractory to diuretics, however, consideration for early determination of diuretic resistance and early initiation of ultrafiltration can provide an effective strategy for decongestion in HF patients. Implementation of ultrafiltration in these instances can improve patient outcomes and potentially be cost saving. The data presented at HFSA demonstrates the safety and effectiveness of ultrafiltration in acute decompensated HF patients. [A future] manuscript will focus on how this therapy can be implemented in clinical practice to support better HF outcomes.”