Nitroglycerin vs. Furosemide Using Lung Ultrasound Pilot Trial
Status:
Recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Nearly 80% of acute heart failure (AHF) patients admitted to the hospital are initially
treated in the emergency department (ED). Once admitted, within 30 days post-discharge, 27%
of patients are re-hospitalized or die. Attempts to improve outcomes with novel therapies
have all failed. The evidence for existing AHF therapies are poor: No currently used AHF
treatment is known to improve outcomes. ED treatment is largely the same today as 40 years
ago. Congestion, such as difficulty breathing, weight gain, and leg swelling, is the primary
reason why patients present to the hospital for AHF. Treating congestion is the cornerstone
of AHF management. Yet half of all AHF patients leave the hospital inadequately decongested.
Although it is the investigators' belief patients are often inadequately decongested in the
ED, it is common teaching within emergency medicine to focus on vasodilators and avoid or
minimize diuretics, especially in those patients with elevated blood pressure. This practice
is largely driven by retrospective analyses or small studies suggesting vasodilators are
efficacious and IV loop diuretics may be associated with harm. The evidence base to guide
early ED management is poor, and the AHA/ACC guidelines provide little to no guidance for ED
treatment. This reflects the lack of high quality data, a critical unmet need that the
investigators will address in this study.
Using clearance of LUS B-lines as the study endpoint, the investigators will study whether a
diuretic intense vs. nitrate intense strategy achieves better decongestion. Although nearly
two decades old, a small study of 100 patients suggested a nitrate intense strategy led to
better outcomes in AHF patients with pulmonary edema when compared with a diuretic intense
strategy. The investigators aim to perform a small pilot study, in hypertensive patients (SBP
> 140mmHg) to test such a strategy to inform a larger, more definitive multicenter randomized
trial.