Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.
Hailun Qin, Lara E E C Zonneveld, Adriaan A Voors et al.
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In 30 seconds
This exploratory sex-specific analysis of the multicentre randomised PUSH-AHF trial examined natriuresis-guided diuretic therapy versus standard care in 310 patients with acute heart failure, 45% of whom were women. Men assigned to guided therapy had greater mean 24-hour natriuresis than men receiving standard care (443 vs. 354 mmol, p = 0.004); this difference was not seen in women. Guided therapy was associated with a lower risk of 180-day heart-failure rehospitalisation or all-cause mortality in men, but not women. The authors emphasise that these sex-specific patterns require confirmation.
Key findings
- Mean 24-hour natriuresis in men was 443 vs. 354 mmol with guided therapy versus standard care (p = 0.004); in women it was 357 vs. 336 mmol (p = 0.533).
- The 24-hour natriuretic response in women was 23 vs. 52 mmol urinary sodium/mg bumetanide with guided therapy versus standard care (p = 0.001); no significant difference was found in men.
- For 180-day heart-failure rehospitalisation or all-cause mortality, the adjusted HR was 0.51 (95% CI, 0.30-0.86; p = 0.011) in men and 1.40 (95% CI, 0.67-2.91; p = 0.368) in women.
Why it matters
The findings suggest that the measured natriuretic response and clinical outcomes associated with natriuresis-guided diuresis may differ by sex. This is relevant when interpreting trial results and designing further studies of decongestion strategies, but the subgroup patterns are exploratory and do not establish that treatment effects truly differ between men and women.
What to keep in mind
This is an exploratory sex-specific analysis of a trial, and the authors state that the patterns require further investigation and confirmation.