Ter Maaten investigated an adapted strategy for the current treatment. She did this with 310 patients at the UMCG who came in with acute heart failure. The study shows that if the dosage of diuretic medication is adjusted to the amount of salt in the urine, the patients lose fluid more quickly. Thanks to this strategy, patients recover better and die less often during hospitalization. The adjusted dosage also appears to be safe. ‘A higher dose of plasma medication causes a higher workload for the kidneys, but we did not see any deterioration in kidney function in this study,’ says Ter Maaten. ‘This is a great first step towards personalized care for acute heart failure.’
Current treatment is insufficient
There are more than 30,000 hospital admissions for acute heart failure in the Netherlands every year. These patients are often seriously ill when they end up in hospital and only one type of treatment is possible: loop duretics, or diuretics. In patients with heart failure, the heart is less able to pump blood and as a result they retain a lot of fluid. Because the fluid settles in various places in the body, for example behind the lungs, patients are very short of breath.
By stimulating urination, they lose that fluid. ‘This medication is insufficiently effective in half of the patients’, says cardiologist and principal researcher Jozine ter Maaten. ‘Because they don’t recover, many patients stay in hospital for a long time. Many patients also die within six months or are readmitted.’ That is why Ter Maaten conducts research to improve the care for these patients.
Salt as a marker
‘Previous research has already shown that low salt in urine during treatment with diuretics is associated with a higher risk of death or readmission. That’s why we asked ourselves: if we look at the amount of salt that patients pass out, do we see how well the medication works? And can we then use this to provide personalized and more effective treatment?’
Test entered immediately
At the UMCG, the new strategy was immediately introduced in the treatment of these patients. Ter Maaten advises other hospitals to do the same. Follow-up research by Ter Maaten’s team together with American scientists should show whether patients who are treated in this way are less likely to end up in hospital again and die less often.
Research with Dekkerbeurs
Ter Maaten received a Dekker grant from the Dutch Heart Foundation two and a half years ago for this research. She also recently received a Veni grant to investigate the role of fluid and salt in acute heart failure.
2023-08-28 13:37:37
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