ADVOR Trial Acetazolamide — EECC MCQ

Correct answer: B — Adding IV acetazolamide (500 mg daily for 3 days) to standard IV loop diuretic therapy in acute decompensated HF improved decongestion and natriuresis compared with placebo, without worsening renal function

The ADVOR trial (2022) randomised 519 patients hospitalised for acute HF with signs of volume overload to IV acetazolamide 500 mg daily for 3 days (added to standardised IV loop diuretic) vs placebo. Acetazolamide (a carbonic anhydrase inhibitor that inhibits proximal tubular sodium reabsorption) significantly increased the proportion of patients achieving successful decongestion (complete diuretic response) at 3 days (42.2% vs 30.5%) without significant differences in death, HF rehospitalisation, or worsening renal function. This provides a new tool for sequential nephron blockade. The 2023 ESC HF Guidelines acknowledge this evidence, adding acetazolamide as an option for overcoming diuretic resistance alongside metolazone and IV chlorothiazide.

Reference: ESC (2023): HF Guidelines; ADVOR Trial