Assessing the Clinical Outcomes of Dapagliflozin Versus Acetazolamide in Patients With Acute Heart Failure

Inclusion criteria

• Adults aged 18 years or older who are hospitalized for hypervolemic AHF, with evidence of congestion defined as either:

• 2 of the following signs or symptoms: peripheral edema, ascites, jugular venous pressure > 10mmHg, orthopnea, paroxysmal nocturnal dyspnea, 5-pound weight gain, or signs of congestion on chest x-ray or lung ultrasound. OR
• If pulmonary artery catheterization is available, a pulmonary capillary wedge pressure greater than 19 mmHg plus a systemic physical exam finding of hypervolemia from the list above.
• Randomized within 24 hours of hospitalization for AHF.
• Planned use of IV loop diuretic therapy during current hospitalization
• Estimated glomerular filtration rate (eGFR) of at least 30 ml/min/1.73m2 by the MDRD equation.

Exclusion criteria

• Unable to follow instructions.
• Treated with any proximal tubular diuretics.
• Systolic blood pressure of less than 90 mm Hg.
• An estimated glomerular filtration rate (GFR) of less than 20 ml per 1.73 m2 of body-surface area.
• Type 1 diabetes mellitus.
• Dyspnea is primarily due to non-cardiac causes.
• Cardiogenic shock.
• Acute coronary syndrome within 30 days prior to randomization.
• Planned or recent percutaneous or surgical coronary intervention within 30 days prior to randomization.
• Signs of ketoacidosis and/or hyperosmolar hyperglycemic syndrome (pH>7.30 and glucose >15 mmol/L and HCO3>18 mmol/L).
• Pregnant or nursing (lactating) women.