Abstract P2040: Metolazone As An Adjunct To Loop Diuretics In Acute Heart Failure: A Systematic Review And Meta-analysis

Abstract

Introduction: Acute heart failure (AHF) affects a significant proportion of the US population. The first-line therapy for decompensated AHF is loop diuretics. However, diuretic resistance in AHF cases is common. In such cases, as add-on therapy, thiazide diuretics are often used to combine two different mechanisms of action. However, the certainty of effectiveness and safety profiles of combining diuretics in cases of diuretic-resistant AHF has not been evaluated in systematic review and meta-analysis considering metolazone, so this study was proposed. Methods: The review protocol was registered in PROSPERO (CRD42022302399). PRISMA guideline was followed. Databases were searched using appropriate keywords for eligible papers published before January 5, 2022. The database was screened using the Covidence platform, and analysis was done using Review Manager (RevMan-5.1) software. Odds ratio or mean difference with 95% CI were estimated using fixed or random effect models based on heterogeneity. Results: Eight studies among 2999 studies met the inclusion criteria (2 RCTs, six observational studies). The pooled analysis showed no difference in standardized mean difference among the metolazone group and the control group for 24-hours of total urine output (SMD 0.10, CI -0.40 to 0.60) and change in 24-hour 48-hour urine output and 72-hour urine output. There was no difference comparing the addition of metolazone or chlorothiazide to furosemide. However, pooling of the result among those studies comparing furosemide and metolazone with furosemide alone showed a significant increase in the 24-hour total urine output metolazone group (SMD 0.50, CI -0.00 to 0.99). Other outcomes like weight loss, mortality, readmission rate, adverse events did not differ across treatment and control groups. Conclusion: Though some benefit in 24-hour urine output was noted on the addition of metolazone to furosemide, our analysis could not demonstrate the benefit of adding metolazone due to lack of adequate studies comparing similar groups in diuretic resistant AHF. Therefore, further RCTs are required in this subject to evaluate the benefit of adding metolazone in diuretic-resistant AHF patients.