PotassiumNEW2026-09

Vasodilation, loop diuretics, or their combination in acute heart failure: Rationale and design of the randomized placebo-controlled DECONGEST-AHF trial.

Olesen Anne Sophie Overgaard, Lukoschewitz Jasmin Dam, Taraldsen Ida Arentz, Najim Ahmed et al. — American heart journal

Summary

This paper outlines the plan for a major study called DECONGEST-AHF, which aims to find the best initial treatment for acute heart failure. It will compare the effects of two common medications, loop diuretics and vasodilators, used alone or together, in patients arriving at the emergency department. The goal is to determine which approach leads to better outcomes, such as more days spent alive and out of the hospital.

AI-generated summary — read the original

Key points

This paper describes the design of a new study investigating early treatments for acute heart failure.
The study will compare loop diuretics, vasodilators, or a combination of both in emergency heart failure patients.
It aims to determine which initial treatment strategy improves patient outcomes, like time spent alive and outside the hospital.
The trial is designed to include a broad range of real-world patients, ensuring its findings will be widely applicable.

What the study looked at

What question the study asked: This paper introduces the DECONGEST-AHF trial, which is designed to answer a critical question: What is the most effective initial treatment strategy for patients experiencing acute heart failure? Specifically, it aims to compare the individual and combined effects of two commonly used medications – loop diuretics and vasodilators – during the very early stages of a heart failure episode. How it was studied: The DECONGEST-AHF trial is a large, multicenter, randomized, double-blinded, and placebo-controlled study. It will involve 1,041 patients across five Danish hospitals who arrive at the emergency department with suspected acute heart failure. Patients are included very quickly, within three hours of arrival, and are randomly assigned to receive either an intravenous loop diuretic (furosemide), an intravenous vasodilator (isosorbide dinitrate), or both. What it found: This paper describes the *plan* for the DECONGEST-AHF trial, rather than presenting its results. The study is currently underway and is designed to find out which of these early treatment approaches leads to better outcomes, measured by the number of days patients are alive and out of the hospital within 30 days. The findings, once available, are expected to improve the initial care for acute heart failure patients.

Dietary takeaway

While this paper describes a study design and not its results, it highlights treatments for acute heart failure that often involve loop diuretics. These medications, like furosemide, are known to increase the excretion of potassium from the body, potentially leading to low potassium levels. Therefore, individuals with heart failure, especially those on diuretics, should work closely with their healthcare provider to monitor potassium and manage their diet accordingly. It's important to remember that this paper outlines a study plan, and its future findings will contribute to our understanding, but no single study provides all the answers.

Abstract

BACKGROUND: Acute heart failure is the leading cause of hospitalization in older adults and carries a high risk of short-term death or readmission. Initial treatment involves intravenous loop diuretics, often combined with vasodilators, despite limited evidence. The individual and combined effects of loop diuretics and vasodilators have never been directly compared during the initial emergency phase, as previous studies have included patients after early stabilization, leaving the optimal first-line treatment unknown. STUDY DESIGN: DECONGEST-AHF is a pragmatic, multicenter, randomized, double-blinded, placebo-controlled trial evaluating early treatment strategies in patients with suspected acute heart failure. Patients are included no later than 3 hours after emergency department arrival. Inclusion criteria are acute dyspnea, clinical signs of congestion, oxygen saturation <94% or need for oxygen therapy, and systolic blood pressure ≥100 mmHg. Patients are randomized (1:1:1) to receive intravenous furosemide, intravenous isosorbide dinitrate, or both as initial in-hospital treatment. The primary outcome is days alive and outside of the hospital at 30 days. The trial will enroll 1,041 patients across 5 Danish hospitals. DISCUSSION: By initiating treatment during the hyperacute phase and applying a blinded and placebo-controlled design, we aim to clarify the individual and combined effects of 2 widely used therapies. The use of emergency consent procedures enables the inclusion of a real-world patient population, including patients who are often excluded from clinical trials. This approach ensures broad generalizability and reflects routine emergency care. Findings from DECONGEST-AHF may improve early management of patients with acute heart failure. TRIAL REGISTRATION: ClinicalTrials.gov identifier:(NCT05276219).

View on PubMed →DOI: 10.1016/j.ahj.2026.107461