Prospective Comparison of Metolazone Versus Chlorothiazide for Acute Decompensated Heart Failure With Diuretic Resistance

University of Virginia

Status and phase

Terminated

Phase 4

Conditions

Cardiovascular Diseases

Heart Failure With Reduced Ejection Fraction

Heart Failure

Heart Failure Acute

Treatments

Drug: Metolazone Oral Tablet

Drug: Chlorothiazide Injection

Study type

Interventional

Funder types

Other

Identifiers

NCT03574857

20455

Details and patient eligibility

About

The primary objective of the study is to compare efficacy of metolazone and chlorothiazide as add-on therapy in patients refractory to loop diuretics with heart failure with a reduced ejection fraction (HFrEF). This will be a single-center randomized pilot study.

Enrollment

5 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age > 18 years old
Admitted for acute decompensated HF with left ventricular ejection fraction (LVEF) <40%
Refractory fluid overload:
Unresponsive (<500 mL net negative over previous 24 hours) AND ineffective diuresis (determined by HF team) to moderate intensity push or low intensity continuous infusion loop diuretic (80 mg IV furosemide or equivalent bumetanide dose of 4 mg)
English or Spanish-speaking subjects
Willing and able to comply with study procedures

Exclusion criteria

Baseline thiazide use prior to admission or prior to study enrollment
Renal replacement therapies (RRT) or glomerular filtration rate (GFR) <30 mL/min at the time of enrollment
Pregnant women
Cognitive impairment
Prisoners
Left ventricular assist devices (LVAD) or temporary mechanical circulatory support devices
History of cardiac transplant
Reported allergy to thiazides
No enteral access or unable to take medications enterally
Palliative diuretics
Systolic blood pressure (SBP) <90 mm Hg prior to randomization
Patients receiving concomitant lithium therapy