Julie Kiranjot Kaur Vishram-Nielsen - Postdoctoral Fellowship 2025
Project summary:
Randomized comparisons of systematic assessment of volume status and choice of loop diuretic at discharge in acute decompensated heart failure
Randomized trial for improving decongestion in acute decompensated heart failure. A significant number of acute decompensated heart failure (ADHF) patients experience recurrent events such as rehospitalization for congestion. Improving the assessment of decongestion during hospitalization and optimizing the continued decongestive treatment once the patient is discharged might mitigate this risk. This study will provide us with unique knowledge regarding the optimal assessment and treatment of decongestion in ADHF patients.
Project Title
Randomized comparisons of systematic assessment of volume status and choice of loop diuretic at discharge in acute decompensated heart failure
Background
The prognosis of patients with acute decompensated heart failure (ADHF) who are admitted to the hospital for decongestion is poor. Although international guidelines recommend that ADHF patients are fully decongested prior to discharge, this target is not met in around one third of ADHF patients. To date, there are no detailed recommendations on how to ensure sufficient decongestion during hospitalization. We propose to investigate a systematic way to assess volume status before discharge and improve home maintenance diuretic therapy after discharge.
Aim
To determine whether a systematic assessment of congestion compared to standard assessment at the time of discharge in hospitalized ADHF patients (trial 1), as well as whether oral bumetanide compared to furosemide given around the time of discharge (trial 2) significantly improves patient outcomes.
Methods
Trial 1 is a randomized, double-blinded study testing four discharge strategies for ADHF patients, varying in the amount of congestion-related diagnostic data provided. The main goal is to assess change in NTproBNP levels 30 days post-discharge.
Trial 2 is an open-label, crossover, cluster-randomized trial comparing oral bumetanide vs. furosemide during hospital discharge. Its primary outcome is death, HF readmission, or worsening heart failure at 1-, 3-, and 5-year follow-up.
Julie Kiranjot Kaur Vishram-Nielsen
- MD and PhD
- Zealand University Hospital – Roskilde, Department of Cardiology
Mentors:
Matias Greve Lindholm, MD, PhD, Head of the Department of Cardiology, Zealand University Hospital, Roskilde
Professor Niels Eske Bruun, MD, PhD, Head of Research Unit at the Department of Cardiology, Zealand University Hospital, Roskilde
International collaborators:
Professor Frederik Verbrugge, MD, PhD, Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
Associate Professor Ana Carolina Alba, MD, PhD, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada