Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes

Lauren B. Cooper, Robert J. Mentz, Dianne Gallup, Anuradha Lala, Adam D. DeVore, Justin M. Vader, Omar Abou Ezzeddine, Bradley A. Bart, Kevin J. Anstrom, Adrian F. Hernandez, G. Michael Felker

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. Methods and Results For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72–96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro–B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs −0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). Conclusions In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.

Original languageEnglish (US)
Pages (from-to)738-742
Number of pages5
JournalJournal of Cardiac Failure
Volume22
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Bicarbonates
Heart Failure
Serum
Therapeutics
Natriuretic Peptides
Ultrafiltration
Kidney

Keywords

  • Diuretics
  • Edema
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cooper, L. B., Mentz, R. J., Gallup, D., Lala, A., DeVore, A. D., Vader, J. M., ... Felker, G. M. (2016). Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes. Journal of Cardiac Failure, 22(9), 738-742. https://doi.org/10.1016/j.cardfail.2016.01.007

Serum Bicarbonate in Acute Heart Failure : Relationship to Treatment Strategies and Clinical Outcomes. / Cooper, Lauren B.; Mentz, Robert J.; Gallup, Dianne; Lala, Anuradha; DeVore, Adam D.; Vader, Justin M.; Abou Ezzeddine, Omar; Bart, Bradley A.; Anstrom, Kevin J.; Hernandez, Adrian F.; Felker, G. Michael.

In: Journal of Cardiac Failure, Vol. 22, No. 9, 01.09.2016, p. 738-742.

Research output: Contribution to journalArticle

Cooper, LB, Mentz, RJ, Gallup, D, Lala, A, DeVore, AD, Vader, JM, Abou Ezzeddine, O, Bart, BA, Anstrom, KJ, Hernandez, AF & Felker, GM 2016, 'Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes', Journal of Cardiac Failure, vol. 22, no. 9, pp. 738-742. https://doi.org/10.1016/j.cardfail.2016.01.007
Cooper, Lauren B. ; Mentz, Robert J. ; Gallup, Dianne ; Lala, Anuradha ; DeVore, Adam D. ; Vader, Justin M. ; Abou Ezzeddine, Omar ; Bart, Bradley A. ; Anstrom, Kevin J. ; Hernandez, Adrian F. ; Felker, G. Michael. / Serum Bicarbonate in Acute Heart Failure : Relationship to Treatment Strategies and Clinical Outcomes. In: Journal of Cardiac Failure. 2016 ; Vol. 22, No. 9. pp. 738-742.
@article{609e4919eb414105995e77376f80a4c9,
title = "Serum Bicarbonate in Acute Heart Failure: Relationship to Treatment Strategies and Clinical Outcomes",
abstract = "Background Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. Methods and Results For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72–96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro–B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs −0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). Conclusions In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.",
keywords = "Diuretics, Edema, Heart failure",
author = "Cooper, {Lauren B.} and Mentz, {Robert J.} and Dianne Gallup and Anuradha Lala and DeVore, {Adam D.} and Vader, {Justin M.} and {Abou Ezzeddine}, Omar and Bart, {Bradley A.} and Anstrom, {Kevin J.} and Hernandez, {Adrian F.} and Felker, {G. Michael}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.cardfail.2016.01.007",
language = "English (US)",
volume = "22",
pages = "738--742",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "9",

}

TY - JOUR

T1 - Serum Bicarbonate in Acute Heart Failure

T2 - Relationship to Treatment Strategies and Clinical Outcomes

AU - Cooper, Lauren B.

AU - Mentz, Robert J.

AU - Gallup, Dianne

AU - Lala, Anuradha

AU - DeVore, Adam D.

AU - Vader, Justin M.

AU - Abou Ezzeddine, Omar

AU - Bart, Bradley A.

AU - Anstrom, Kevin J.

AU - Hernandez, Adrian F.

AU - Felker, G. Michael

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. Methods and Results For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72–96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro–B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs −0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). Conclusions In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.

AB - Background Though commonly noted in clinical practice, it is unknown if decongestion in acute heart failure (AHF) results in increased serum bicarbonate. Methods and Results For 678 AHF patients in the DOSE-AHF, CARRESS-HF, and ROSE-AHF trials, we assessed change in bicarbonate (baseline to 72–96 hours) according to decongestion strategy, and the relationship between bicarbonate change and protocol-defined decongestion. Median baseline bicarbonate was 28 mEq/L. Patients with baseline bicarbonate ≥28 mEq/L had lower ejection fraction, worse renal function and higher N-terminal pro–B-type natriuretic peptide than those with baseline bicarbonate <28 mEq/L. There were no differences in bicarbonate change between treatment groups in DOSE-AHF or ROSE-AHF (all P > .1). In CARRESS-HF, bicarbonate increased with pharmacologic care but decreased with ultrafiltration (median +3.3 vs −0.9 mEq/L, respectively; P < .001). Bicarbonate change was not associated with successful decongestion (P > .2 for all trials). Conclusions In AHF, serum bicarbonate is most commonly elevated in patients with more severe heart failure. Despite being used in clinical practice as an indicator for decongestion, change in serum bicarbonate was not associated with significant decongestion.

KW - Diuretics

KW - Edema

KW - Heart failure

UR - http://www.scopus.com/inward/record.url?scp=84957928373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84957928373&partnerID=8YFLogxK

U2 - 10.1016/j.cardfail.2016.01.007

DO - 10.1016/j.cardfail.2016.01.007

M3 - Article

C2 - 26777758

AN - SCOPUS:84957928373

VL - 22

SP - 738

EP - 742

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 9

ER -