Early Ultrafiltration in Patients With Decompensated Heart Failure and Diuretic Resistance

Costanzo, María Rosa; Saltzberg, Mitchell T.; O'Sullivan, Jeanne; Sobotka, Paul

doi:10.1016/j.jacc.2005.05.099

Cited by 219 publications

(133 citation statements)

References 15 publications

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“…Ultrafiltration has been shown to be a safe and effective treatment to reduce congestion in patients with decompensated HF and diuretic resistance [52].…”

Section: Diureticsmentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

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Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

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“…Ultrafiltration has been shown to be a safe and effective treatment to reduce congestion in patients with decompensated HF and diuretic resistance [52].…”

Section: Diureticsmentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

357

242

View full text Add to dashboard Cite

show abstract

“…In 2005, 13 investigators reported that 20 patients had fewer rehospitalizations following an index admission utilizing UF when compared with the historic rate for these same individuals. More than 3 months prior to UF, 9 patients had 10 admissions; in the 30 days following the filtration, there was only 1 HF hospitalization.…”

Section: Hospital Readmissionsmentioning

confidence: 99%

Ultrafiltration for Acute Decompensated Heart Failure: Cost, Reimbursement, and Financial Impact

Ross

Bellamy

Hawig

et al. 2011

Clinical Cardiology

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In addition to the proposed pathophysiologic mechanisms whereby ultrafiltration (UF) can be advantageous over diuretics in the treatment of heart failure, there can also be financial and resource-utilization reasons for pursuing this extracorporeal strategy. In those cases in which the clinical outcomes would be equivalent, however, the decision whether to pursue UF will depend greatly on the anticipated hospitalization length of stay (LOS), the patient population's payor mix, the needs and costs for high-acuity (eg, intensive care unit) care, and widely varying expenses for the equipment and disposable supplies. From a fiscal perspective, the financial viability of UF programs revolves around how improvements in LOS, resource utilization, and readmissions relate to the typical diagnosis-driven (eg, diagnosis-related group) reimbursement. We analyzed the impact of these various factors so as to better understand how the intensity (and expense) of pharmaceutical and extracorporeal therapies impacts a single admission, as well as to serve as the basis for developing strategies for optimizing long-term care.

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“…While intravenous vasodilator therapy can be very effective in such patients, mechanical means to remove fluid have been developed that do not require traditional dialysis. This method is called ultrafiltration, which is achieved through infusing venous blood through a powered circuit designed to remove sodium and fluid but not large solutes (46,47). Because the circuit is not powered by the systemic blood pressure of the patient, it can be performed in those who cannot receive vasodilators due to hypotension.…”

Section: Mechanical Fluid Removalmentioning

confidence: 99%

Current treatment options for early management in acute decompensated heart failure

Howlett¹

2008

Canadian Journal of Cardiology

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Early Ultrafiltration in Patients With Decompensated Heart Failure and Diuretic Resistance

Abstract: In heart failure patients with volume overload and diuretic resistance, ultrafiltration before IV diuretics effectively and safely decreases length of stay and readmissions. Clinical benefits persist at three months.

Cited by 219 publications

References 15 publications

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Ultrafiltration for Acute Decompensated Heart Failure: Cost, Reimbursement, and Financial Impact

Current treatment options for early management in acute decompensated heart failure

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