Clinical policy ultrafiltration for heart failure page 4 of 6 9. Acute decompensated heart failure ultrafiltration system. A practical guide for ultrafiltration in acute decompensated heart failure acute decompensated heart failure is the most common reason for inpatient hospital admission. Outcome measures heart failure is a condition with a variable natural history and multiple confounders of outcome. A practical guide for ultrafiltration in acute decompensated heart. Although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure. Extracorporeal ultrafiltration for fluid overload in heart. Ultrafiltration in decompensated heart failure n engl j med 3 duration of the ultrafiltration intervention. Ultrafiltration versus intravenous diuretics in decompensated heart failure. Effectiveness of ultrafiltration in patients with congestive. Although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure with acute cardiorenal system type 1, the first clinical trial to test its value shows that it is inferior to standard drug therapy. Diuretics and ultrafiltration in acute decompensated heart. Ultrafiltration removes fluid from the blood by using pressure differentials with dialysis equipment or similar filtration devices.
Venovenous ultrafiltration can be performed with either peripheral, midline, or central access. The unload trial group recently reported results from a randomized trial of ultrafiltration using the aquadex machine compared with diuretics for acute decompensated heart failure. Mittal division of cardiovascular medicine, university of missouri school of medicine, columbia, missouri, usa. Braden, md1 in patients with acute decompensated heart failure adhf, treatment aimed at adequate decongestion of. Role of isolated ultrafiltration in the management of. Ultrafiltration in decompensated heart failure with. Three recent studies suggest that failure to adequately reduce fluid excess in patients with acutely decompensated heart failure trumps increases in serum creatinine in predicting poor outcomes. In practice decongestive treatment of acute decompensated heart failure. Effectiveness of ultrafiltration in treating people with acute decompensated heart failure and cardiorenal syndrome the carress study carress the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The costs with hospitalization for decompensated heart failure reach approximately 60% of the total cost with heart failure treatment, and mortality during hospitalization varies according to the studied population, and could achieve values of 10%. Those in the uf group received an 8 hour uf treatment with a maximum fluid removal rate of 500 cc. Patients randomized to the usual care group received the conventional heart failure therapy.
Effectiveness of ultrafiltration in patients with congestive heart failure. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance maria rosa costanzo, mitchell saltzberg, jeanne osullivan, paul sobotka ultrafiltration was used before intravenous diuretics in 20 patients with volume overload and diuretic resistance. In this chapter, we shed light on the role of different methods of ultrafiltration, including. Ultrafiltration for volume control in decompensated heart. Bart ba 1, goldsmith sr, lee kl, givertz mm, oconnor cm, bull da. Ultrafiltration system for salt and water removal using a low volume of extracorporeal blood through peripheral or central venous access chf solutions inc. Ultrafiltration in decompensated heart failure request pdf. Ultrafiltration in patients with decompensated heart. The system minimises the risk of haemodynamic interference by using a low blood flow via a smallbore cannula inserted into a peripheral or central vein. Ultrafiltration for acute decompensated heart failure. When a persons condition worsens to the point of hospitalization, that person is said to have acute decompensated heart failure adhf. Seven studies on ultrafiltration presented at heart. Cardiorenal outcomes after slow continuous ultrafiltration therapy in refractory patients with advanced decompensated heart failure.
Pdf ultrafiltration in decompensated heart failure with. Ultrafiltration is a method used to achieve diuresis in acute decompensated heart failure adhf when there is diuretic resistance, but its efficacy in other settings is unclear. We performed metaanalysis to determine its role in reducing readmissions after acute decompensated heart failure. Decongestive treatment of acute decompensated heart. Acute decompensated heart failure is a common and a serious cause for acute respiratory distress. The impact of ultrafiltration in acute decompensated heart failure. Acute decompensated heart failure adhf is a syndrome defined by worsening fatigue, dyspnea, or edema that results from deteriorating heart function and usually leads to hospital admission or unscheduled medical intervention. Acute decompensated heart failure adhf remains the leading cause of hospitalization in. Ultrafiltration for the treatment of congestive heart failure notice. Ultrafiltration for the treatment of congestive heart failure. Effectiveness of ultrafiltration in treating people with. Ultrafiltration, an alternative method of sodium and water removal, safely improves hemodynamics in heart failure patients. Uf recommendations for hf from the 20 guideline by the american college.
Fluid congestion is the hallmark of decompensated heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function. Most patients admitted for decompensated heart failure are by definition diureticresistant. Extracorporeal ultrafiltration for acute heart failure. Ultrafiltration in the management of heart failure.
Several recent studies of patients with acute decompensated heart failure have compared the efficacy of ultrafiltration and diuretics 88,90,91. Early ultrafiltration in patients with decompensated heart. Another study supporting the findings of the rapidchf trial was the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial. The role of ultrafiltration in patients with decompensated. Efficacy and safety of ultrafiltration in decompensated heart failure patients with renal insufficiency. Dec, 2012 ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. The trial was called the rapidchf study, which stands for relief for acutely fluid overloaded patients with decompensated congestive heart failure. Abstract the aim of the best practice guidelines on peritoneal ultrafiltration uf in patients with treatmentresistant advanced decompensated heart failure trahdf is to achieve a common. Readmission rate after ultrafiltration in acute decompensated. Heart failure is a serious condition in which the heart s ability to pump blood through the body is impaired, often making a person feel weak or fatigued. Pdf decongestive treatment of acute decompensated heart.
October 30, 2008 chf solutions said seven studies supporting ultrafiltration therapys effectiveness and benefits in treating fluid overload in heart failure patients were presented at the recent heart failure society of america hfsa 2008 annual scientific meeting in toronto, canada. Diuretics on clinical, biohumoral and hemodynamic variables in patients with decompensated heart failure study, at 36 h, compared with the diuretic agent group, the uf patients had greater reduction in body weight, signs and symptoms of heart failure, aldosterone and nterminal probtype. Heart failure is a disease with high incidence and prevalence in the population. The purpose of this randomized controlled trial was to study the safety and effectiveness of early treatment with primary uf in patients with adhf. Significance of ultrafiltration in acute decompensated heart failure remains unclear. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure mayank k. Some studies, like the cardiorenal rescue study in acute decompensated heart failure carresshf36 and the aquapheresis versus intravenous diuretics and hospitalization for heart failure avoidhf trials,35 have observed a higher frequency of adverse events in patients treated with ultrafiltration, raising some concerns regarding its safety. Diuretics and ultrafiltration in acute decompensated heart failure. Characteristics and outcomes of patients hospitalized for heart failure in the united states.
Such patients are resource intensive utilizers of hospital services and can often result in a net fiscal loss for the average hospital stay. Congestive heart failure is a relatively common problem and frequently results in. Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Pdf congestion is the predominant cause of more than 1 million annual heart failure hospitalisations and recurrent fluid overload predicts poor. Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure. Pdf peritoneal ultrafiltration in patients with advanced.
We conducted a retrospective cohort study to examine the efficacy and safety of ultrafiltration. Ultrafiltration in decompensated heart failure coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the members specific benefit plan. Peripheral ultrafiltration for acute decompensated heart failure. Despite advances in the therapy of heart failure hf, it continues to be the most common reason for hospitalization of patients age 65 years and presents an enormous burden to the healthcare system. In the setting of congestive heart failure, ultrafiltration has been associated with a reduced incidence of hospitalization compared with diuretics in the unload trial, but no difference in mortality. The negative prognostic impact of worsening renal function in patients with decompensated heart failure has been widely recognised. Diuretics or ultrafiltration for acute decompensated heart. The ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial evaluated the safety and efficacy of early primary ultrafiltration. The economic impact of ultrafiltration as an initial strategy for decompensated heart failure was also not addressed in this trial. As heart failure progresses, reduced response to diuretics is common. Ultrafiltration in patients with decompensated heart failure.
These include dyspnea difficulty in breathing, swelling in feet or legs and fatigue. Ultrafiltration in decompensated heart failure disclaimerinstructions for use medical policy provides general guidance for applying blue cross of idaho benefit plans for purposes of medical policy, the terms benefit plan and member contract are used interchangeably. Recent findings the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure trial has recently shown. Ultrafiltration was performed at a fluidremoval rate of 200 ml per hour. Aetna considers ultrafiltration medically necessary for the acute management of inpatient. Peripheral ultrafiltration for acute decompensated heart failure clinical policy bulletins medical clinical policy bulletins number.
Most patients admitted for decompensated heart failure are by definition. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. Ultrafiltration for acute decompensated heart failure, while not a new concept, has recently generated greater clinical interest with the development of a portable machine that does not require intensive care unit monitoring or travel to a dialysis ward. While the costs associated with ultrafiltration during the index hospitalization may exceed those of intravenous diuretics, total cost over time may be lower due to decreased resource utilization for heart failure. Nov 06, 2012 although ultrafiltration uf in recent years has become increasingly popular as an alternative to intravenous diuretics for patients with acute decompensated heart failure with acute cardiorenal. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload. A clinical study designed by researchers compared the safety and efficacy of diuretic drugs with that of ultrafiltration. Background congestive heart failure chf heart failure hf is a major public health problem in the united states.
Freda, do,1 mara slawsky, md, phd,2 jaya mallidi, md, mhs,3 and gregory l. Extracorporeal ultrafiltration for fluid overload in heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by. Mrc served as the principal investigator of the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload and aquapheresis versus intravenous diuretics and hospitalization for heart failure avoidhf clinical trials and her institution received a research grant related to the studies. Requests directly related to medical policy content or requests for clinical criteria may be sent to the medical policy operations specialist via email, fax, phone or mail. Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. We sought to determine if ultrafiltration before intravenous iv diuretics in patients with decompensated heart failure and diuretic resistance results in euvolemia and early discharge without hypotension or worsening renal function. This medical coverage guideline must be read in its entirety to determine coverage eligibility, if any. Early ultrafiltration in patients with decompensated heart failure and diuretic resistance. In the continuous ultrafiltration for congestive heart failure cuore trial, 27 uftreated patients had fewer. In the united states, more than 1 million patients are admitted annually for acute decompensated heart failure adhf. Slow continuous ultrafiltration scuf uses a hydrostatic pressure difference p between the blood and nonblood sides of the membrane dotted line within the dialyzer to remove water and solutes from the plasma by ultrafiltration. Article pdf available in journal of nephrology j nephrol26.
The economics and reimbursement of congestive heart failure. Ultrafiltration for the treatment of congestive heart. Pdf ultrafiltration in acute heart failure researchgate. Diuretics are the mainstay of therapy for restoring the euvolaemic state in patients with decompensated heart failure. Ultrafiltration for acute decompensated cardiac failure. Newer devices that allow continuous ultrafiltration in ambulatory patients are under investigation to reduce volume overload. Decompensated heart failure an overview sciencedirect.
Request pdf ultrafiltration in decompensated heart failure fluid congestion is the hallmark of decompensated heart failure. Ultrafiltration is sometimes utilized in decompensated heart failure as an alternative therapy to diuretics for restoring fluid balance. Kaiser foundation health plan of washington and kaiser foundation health plan of washington options, inc. Ultrafiltration is a technique being evaluated for removal of excess fluid from patient with volume overload and heart failure. Pdf ultrafiltration for decompensated heart failure.
Ultrafiltration removes plasma water from whole blood. Blackwells programme has been merged with wileys global scientific, technical. The therapeutic objective for these patients is volume and sodium. Moreover, many patients with adhf are discharged without clinical evidence of adequate decongestion. Compared with diuretics, ultrafiltration provides a more predictable and safer way to achieve euvolemia with minimal electrolyte abnormalities and. Ultrafiltration in decompensated heart failure springerlink. Dialytic techniques used in decompensated heart failure. Background ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure.
As diuretics are thought to contribute to deterioration of. Acute decompensated heart failure physiology and treatment with dr. Ultrafiltration in decompensated heart failure n engl j med 367. The impact of ultrafiltration in acute decompensated heart. Sustained lowefficiency dialysis sled has the additional feature of dialysis fluid passed through the. Ultrafiltration using the aquadex flexflow aquapheresis system can remove up to 500mls excess salt and water per hour from the circulation of patients with heart failure and fluid overload. Ultrafiltration versus intravenous diuretics for patients. Reprinted, with permission, from mather and konstam. Ultrafiltration in acute decompensated heart failure. Cardiorenal implications of ultrafiltration and diuretics. Ultrafiltration fails to show benefit in acute heart failure. Peritoneal ultrafiltration in patients with advanced decompensated heart failure. Decongestive treatment of acute decompensated heart failure. Acute decompensated heart failure adhf is a condition where the patient experiences sudden deterioration of the signs and symptoms of an existing heart failure.
Ultrafiltration has become a therapeutic maneuver in managing decompensated congestive heart failure with refractory volume overload. The acute decompensated heart failure adhf patient poses additional challenges for the hospital facility. Pdf ultrafiltration versus intravenous diuretics in. Aetna considers ultrafiltration medically necessary for the acute management of inpatient members hospitalized with acutely decompensated congestive heart failure chf who have dyspnea at rest or with minimal activity, and have confirmed diuretic resistance defined as dose escalation beyond a persons previously recognized dose ceiling or a dose approaching the maximum. Apr 17, 2020 the ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure unload trial evaluated the safety and efficacy of early primary ultrafiltration. It is a tool for rapid and stabilized fluid removal with volume extraction rates as high as 500 mlh in adults.
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