title: Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes.
abstract: BACKGROUND
  Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate.
  
  
  RESULTS
  For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72-96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro-B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs -0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials).
  
  
  CONCLUSIONS
  In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina. Electronic address: lauren.b.cooper@duke.edu.
authors.forename: Lauren B
authors.initials: LB
authors.lastname: Cooper
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Dianne
authors.initials: D
authors.lastname: Gallup
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts; Mount Sinai School of Medicine, New York, New York.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Lala
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Vader
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Bart
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
mesh_terms: D000208:Acute Disease; D000368:Aged; D001639:Bicarbonates / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D004232:Diuretics
keywords: Diuretics; Edema; Heart failure