title: Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.
abstract: OBJECTIVE
  The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD).
  
  
  BACKGROUND
  Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes.
  
  
  METHODS
  The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF.
  
  
  RESULTS
  A total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar.
  
  
  CONCLUSIONS
  Compared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial's untimely termination, additional AUF investigation is warranted.
authors.affiliation: Advocate Heart Institute, Edward Heart Hospital, Naperville, Illinois. Electronic address: mariarosa.costanzo@advocatehealth.com.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Costanzo
authors.affiliation: Division of Nephrology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Negoianu
authors.affiliation: San Diego Cardiac Center, Sharp Memorial Hospital, San Diego, California.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Jaski
authors.affiliation: Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Bart
authors.affiliation: Heart Failure Recovery & Research Program, Scripps Clinic, San Diego, California.
authors.forename: James T
authors.initials: JT
authors.lastname: Heywood
authors.affiliation: University of Minnesota VA Medical Center, Minneapolis, Minnesota.
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: Huntsville Renal Clinic, Huntsville, Alabama.
authors.forename: James M
authors.initials: JM
authors.lastname: Smelser
authors.affiliation: Oklahoma Heart Institute, Tulsa, Oklahoma.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Kaneshige
authors.affiliation: Saint Thomas Heart Hospital, Nashville, Tennessee.
authors.forename: Don B
authors.initials: DB
authors.lastname: Chomsky
authors.affiliation: Division of Cardiology, University of California, San Diego, California.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Adler
authors.affiliation: Division of Cardiology, Ohio State University, Columbus, Ohio.
authors.forename: Garrie J
authors.initials: GJ
authors.lastname: Haas
authors.affiliation: Brooke Army Medical Center, San Antonio, Texas.
authors.forename: James A
authors.initials: JA
authors.lastname: Watts
authors.affiliation: Baxter Healthcare Corporation, Deerfield, Illinois.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Nabut
authors.affiliation: Baxter Healthcare Corporation, Deerfield, Illinois.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Schollmeyer
authors.affiliation: Division of Cardiology, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods*
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: aquapheresis; congestion; fluid overload; heart failure; hospitalizations; loop diuretics; worsening renal function