Heart, Lung and Circulation

Acetazolamide Reduces Hospital Admissions and Length of Stay in Refractory Heart Failure Patients

      Background: End stage Heart Failure patients with refractory oedema have frequent hospital admissions and increased length of stay (LOS) with resultant morbidity, mortality and cost, despite optimal medications and devices. Acetazolamide is a carbonic anhydrase inhibitor acting on the proximal nephron resulting in added diuresis to standard therapy.
      Method: Over four years, 10 patients with refractory oedema and repeated congestive cardiac failure (CCF) admissions despite maximal tolerated medical therapy and use of multiple diuretics were treated with addition of Acetazolamide at either 125 or 250 mg bd for two of every three days. Hospital admissions and LOS for each patient pre and post Acetazolamide were analysed.
      Results: Ten patients had 34 admissions in 72 months of patient monitoring with LOS 299 days pre Acetazolamide. Over 131 patient months post Acetazolamide there were 20 admissions with LOS 168 days. Mean LOS was reduced from 13.7% to 4.2% (ARR 9.5%, RRR 69%) of days monitored. The five surviving patients at average 13.6 months post Acetazolamide had mean admissions reduced from 3.4 to 1 and LOS reduced from 9% to 1.3% of days monitored (ARR 7.7%, RRR 86%). Mean reduction in LOS for five patients who died (four within 10 months) was from 19% to 7.3% (RR 11.7%, RRR 62%).
      Conclusion: In end stage heart failure patients with refractory oedema and recurrent CCF admissions, the addition of Acetazolamide to standard diuretic therapy results in significantly reduced admissions and LOS thus reducing morbidity and health care costs.