Cardiovascular Clinical Trialists (CVCT) Forum – Paris 2012 - Debate Session 5 : Insights from DOSE and gaps in evidence with diuretic therapy (Alice MASCETTE)

MODIGLIANI Debate Session 5 - Saturday December 1st, 2012 NOVEL DIURETIC STRATEGIES IN HEART FAILURE

Chairpersons: Keld KJELDSEN, Copenhagen, DEN - Gian Paolo ROSSI, Padua, ITA Webcast: Patrick ROSSIGNOL, Nancy, FRA

➢ Clinical congestion due to volume overload is the main cause of hospitalization for patients with HF and is an important therapeutic target. Failure to achieve effective and rapid correction of this condition in many patients hospitalized for HF results in prolongation of hospital stay and unfavorable after-discharge outcome. ➢ Loop diuretics, though often effective for treating congestion, have significant limitations. Discovering ways to optimize exposure to loop diuretics, achieving effective decongestion while protecting renal function, is an important goal of current clinical research in HF. ➢ Vasopressin antagonists are effective in removing large amounts of water, but not salt, in HF. The EVEREST trial in unselected acute systolic heart failure did not show benefit on CV outcomes and only a modest benefit on dyspnea. Whether vaptans in HF are still a viable option is an important question. Better targeting specific vasopressin receptors with highly selective agents, better profiling of patients more likely to benefit, combination with mineralocorticoid receptor antagonists are options that are worth exploring. ➢ Aquapharesis (Ultrafiltration: UF) has been shown to be a safe and effective therapeutic modality for correction of volume overload in hospitalized patients with HF, not responding to intravenous diuretics and vasoactive medications. Should UF replace intravenous diuretics as a first-line therapy for patients with hypervolemia admitted for HF? The validity of such a concept is being examined in the NHLBI larger CARRESS study.

Session program: Insights from DOSE and gaps in evidence with diuretic therapy Speaker: Alice MASCETTE, NHLBI, USA The Vaptans story post-EVEREST. What is next? ACTIVATE, TACTICS and BALANCE trials Speaker: Michael FELKER, Durham, USA Discussant: William T. ABRAHAM, Colombus, USA Ultrafiltration for acute cardiorenal syndrome in heart failure. UNLOAD and AVOID-HF and CARRESS trial Speaker: Gian Paolo ROSSI, Padua, ITA Debate: New diuretic modalities: Remaining gaps in evidence or ready for clinical use?