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Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study

Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study

January 2024 | Jeroen Dauw, MD, MMed; Kristina Charaya, MD, PhD; Malgorzata Lelonek, MD, PhD; Isabel Zegri-Reiriz, MD, PhD; Samer Nasr, MD; Cynthia P. Paredes-Paucar, MD; Attila Borbély, MD, PhD; Fatih Erdal, MD; Riad Benkouar, MD, PhD; Marta Cobo-Marcos, MD; Gonzalo Barge-Caballero, MD, PhD; Varghese George, MD, DMM; Cornelia Zara, MD; Noel T. Ross, MD; Diane Barker, MD; Annop Lekhakul, MD; Simone Frea, MD; Azmee M. Ghazi, MD; Dorit Knappe, MD; Nawal Doghmi, MD; Milka Klincheva, MD, PhD; Inês Fialho, MD; Virginia Bovolo, MD; Hajo Fineusen, MD; Imad A. Alhaddad, MD; Alessandro Galluzzo, MD; Rafael da de Espriella, MD; Ramzi Tabbalat, MD; Óscar Miró, MD, PhD; Jagdeep S. Singh, MBBS, MD; Petra Nijst, MD, PhD; Matthias Dupont, MD; Pieter Martens, MD, PhD; Wilfried Mullens, MD, PhD
The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure (AHF) and signs of volume overload. The study was an international, multicenter, open-label, pragmatic, 2-phase trial comparing the current standard of care with a standardized diuretic protocol that included urinary sodium to guide therapy. The primary endpoint was natriuresis after 1 day, and secondary endpoints included cumulative natriuresis and diuresis after 2 days, length of stay, and in-hospital mortality. Four hundred one patients from 29 centers in 18 countries were included. The protocol arm showed significantly higher natriuresis and diuresis after 1 and 2 days compared to the standard of care arm. The protocol arm also had a shorter length of stay, but in-hospital mortality was low and did not differ between the two arms. The study concluded that a standardized natriuresis-guided diuretic protocol is feasible, safe, and effective in improving diuretic response and reducing length of stay in patients with acute heart failure.The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure (AHF) and signs of volume overload. The study was an international, multicenter, open-label, pragmatic, 2-phase trial comparing the current standard of care with a standardized diuretic protocol that included urinary sodium to guide therapy. The primary endpoint was natriuresis after 1 day, and secondary endpoints included cumulative natriuresis and diuresis after 2 days, length of stay, and in-hospital mortality. Four hundred one patients from 29 centers in 18 countries were included. The protocol arm showed significantly higher natriuresis and diuresis after 1 and 2 days compared to the standard of care arm. The protocol arm also had a shorter length of stay, but in-hospital mortality was low and did not differ between the two arms. The study concluded that a standardized natriuresis-guided diuretic protocol is feasible, safe, and effective in improving diuretic response and reducing length of stay in patients with acute heart failure.
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