Background

• ineffective diuresis and residual volume overload is common and associated with poor outcomes
• Sequential nephron blockade may be more effective than loop monotherapy
  • Limited evidence for this
  • Previous small trial with indapamide
  • 3T trial (2020) - Patients were randomized to oral metolazone, IV chlorothiazide, or tolvaptan therapy.
  • JACC 2019

Acetazolamide

• MOA
  • CA inhibitor
  • Reduces prox tubular Na reabsorption
  • Increases urinary sodium excretion

Links for reading/opinions

1. https://www.tctmd.com/news/old-drug-acetazolamide-offers-new-tricks-acute-hf-advor
2. https://www.wikijournalclub.org/wiki/ADVOR
3. https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2022/08/26/04/07/ADVOR
4. https://www.cfrjournal.com/video-index/esc-22-late-breaker-discussion-advor-trial
5. http://www.nejm.org/doi/10.1056/NEJMoa2203094