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Clinical Pharmacology and Therapeutics

Acetazolamide eased breathlessness more in acute heart failure

A measure combining breathlessness severity and duration was 2,647.9 millimeter-hours with acetazolamide versus 2,988.7 with dapagliflozin over 72 hours; lower scores meant more relief.

Paper by Hossam Sharaf, Moheb Wadie, Noha O. Mansour, Mohamed E. E. Shams · Faculty of Pharmacy Mansoura University Mansoura Egypt
Graphical abstract from Clinical Pharmacology and Therapeutics
Open the figure at full size
Graphical abstract. Sharaf et al.

Our read

Interventions
Studied:
Randomized trial in 108 hospitalized adults with acute heart failure, 3 days, against dapagliflozin (Registered NCT06783166)
What changed:
Breathlessness scores were lower with acetazolamide: 2,647.9 millimeter-hours versus 2,988.7 with dapagliflozin over 72 hours
The catch:
Outcomes covered only three days, leaving longer-term benefits and harms unmeasured
In the record:
One of 9 papers on acetazolamide on record: 6 with results in people, 1 in animals.
Why it’s aging research:
An intervention with evidence on lifespan or healthspan.

Editor of record: Boris Djordjevic · AgingResearch.News

Paper
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All 108 adults in this randomized trial were hospitalized with acute heart failure, breathlessness and evidence of fluid buildup requiring intravenous loop diuretics, drugs that increase urine output. Alongside standard care, 55 received dapagliflozin at 10 mg daily and 53 received acetazolamide at 500 mg daily for three days.

Acetazolamide provided greater breathlessness relief over 72 hours, the main outcome. It also produced more urine over 72 hours: 12,200 versus 10,000 milliliters with dapagliflozin. More sodium left the body in urine over 48 hours with acetazolamide. Dapagliflozin produced a larger reduction in a blood marker of heart strain at 72 hours: 34.2% versus 25.0% with acetazolamide. Safety events were infrequent and similar between groups.

Why it matters

Acute heart failure can bring fluid buildup and breathing difficulties, making symptom relief an important treatment goal in later-life care.

Caveats

The reported outcomes covered only three days and do not establish longer-term benefits or harms. The findings concern hospitalized adults with acute heart failure and fluid buildup, not people with stable heart failure.

Where the evidence stands

Acetazolamide

Worms or flies, mice and humans: a single group. Cells: nothing yet.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

No results posted: trials that ended over a year ago with no results on ClinicalTrials.gov and no paper reporting them.

Company ties: findings with an author at a company, or from a paper whose competing-interests statement declares ties to one.

  • 6 independent labs in 4 countries
  • 68 trials, 23 with no results posted
  • Funders: Swiss National Science Foundation and 5 more
  • 1 of 14 findings with company ties

Dapagliflozin

Cells, mice and humans: replicated by independent labs. Worms or flies: a single group.

C, W, M, H: cells, worms or flies, mice, humans. Dark: independent labs found the same change there. Light: one lab or one study. Outline: nothing yet.

Labs are independent when their papers share no last author and no institution.

Against: findings that point the other way from most findings on the same outcome.

No results posted: trials that ended over a year ago with no results on ClinicalTrials.gov and no paper reporting them.

Company ties: findings with an author at a company, or from a paper whose competing-interests statement declares ties to one.

  • 182 independent labs in 35 countries
  • 48 findings against
  • 414 trials, 102 with no results posted
  • Funders: AstraZeneca and others
  • 97 of 646 findings with company ties
  • 177 of 414 trials sponsored by its developers

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