Acetazolamide in Acute Decompensated Heart Failure with Volume Overload

The ADVOR trial, a multicenter, double-blind, placebo-controlled study, assessed whether intravenous acetazolamide improves decongestion in patients hospitalized with acute decompensated heart failure and volume overload. A total of 519 patients were randomized to receive either 500 mg acetazolamide or placebo daily, alongside standardized loop diuretics. The primary endpoint—successful decongestion within 3 days without therapy escalation—occurred in 42.2% of the acetazolamide group versus 30.5% of the placebo group (risk ratio: 1.46; 95% CI: 1.17–1.82; P<0.001). Acetazolamide enhanced natriuresis and urine output, shortened hospital stay, and improved discharge decongestion rates (78.8% vs. 62.5%), with similar rates of adverse events including renal dysfunction, hypokalemia, and hypotension. No increase in mortality or heart failure rehospitalization was observed over 3 months. The findings support adding acetazolamide to loop diuretics for more efficient, safer decongestion in acute volume

The ADVOR trial, a multicenter, double-blind, placebo-controlled study, assessed whether intravenous acetazolamide improves decongestion in patients hospitalized with acute decompensated heart failure and volume overload. A total of 519 patients were randomized to receive either 500 mg acetazolamide or placebo daily, alongside standardized loop diuretics. The primary endpoint—successful decongestion within 3 days without therapy escalation—occurred in 42.2% of the acetazolamide group versus 30.5% of the placebo group (risk ratio: 1.46; 95% CI: 1.17–1.82; P<0.001). Acetazolamide enhanced natriuresis and urine output, shortened hospital stay, and improved discharge decongestion rates (78.8% vs. 62.5%), with similar rates of adverse events including renal dysfunction, hypokalemia, and hypotension. No increase in mortality or heart failure rehospitalization was observed over 3 months. The findings support adding acetazolamide to loop diuretics for more efficient, safer decongestion in acute volume