PUSH-trial: Treatment of acute heart failure based on urinary sodium
Researchers from the University Medical Centre Groningen proved that treating patients with acute decompensated heart failure based on urinary sodium is better than the standard of care practice. These results have been presented last monday on the European congres of Cardiology and have been published in Nature Medicine.
Patients with acute heart failure in the Netherlands and worldwide are treated with diuretics, which is standard practice. Diuretics improve the clearance of water and sodium through the kidneys. Previous research showed that a worse response on treatment with diuretics has been associated with an increased risk of hospitalization and death. Measuring urine sodium can be an effective parameter for treatment response, but it is unknown whether measuring urinary sodium and changing treatment (increasing the dose of diuretics or adding another agent) based on these sodium value improves outcome.
This is why a team of researchers from the cardiology department of the UMCG investigated whether measuring urinary sodium in patients with acute heart failure and changing therapy based on the results leads to a faster and improved treatment response. This study, performed entirely in the UMCG, included 310 patients and randomized them to standard-of-care or the urine sodium-regulated group. Results showed that the urine sodium-regulated treatment for fluids in patients with acute heart failure led to faster and better removal of excess fluid. There was no improvement in long-term outcome. Basing treatment on urinary sodium we make an important step in personalized treatment of excess fluid in heart failure.
Drs. Beldhuis: “The ultimate goal is to apply this cheap and very accessible marker in all dutch hospitals to individualize treatment for acute heart failure.”
This research could not have been done by the support of the entirety of the cardiology department of the UMCG, including doctors, researchers and nurses. Through this tremendous tem effort we have made a big step in providing a more individualized treatment for patients with acute heart failure.
More information about this research can be found on the website of the UMCG and on the website of the Dutch Heart Foundation. The article can be found on the site of Nature Medicine. Links are provided below:
