Recommendation ID
CG187/4
Question
In people with decompensated heart failure, fluid congestion and diuretic resistance, does ultrafiltration lead to more rapid and effective decongestion compared with continuing diuretictreatment?
Any explanatory notes
(if applicable)
A randomised controlled trial should be undertaken to determine whether ultrafiltration is more
clinically and cost effective than conventional diuretic therapy for people admitted to hospital with
decompensated heart failure. The study should not only investigate several clinical outcomes but
also consider the impact of treatments on quality of life and provide data on safety.
People who have fluid retention that is resistant to conventional diuretic therapy, with or without
renal dysfunction, make up a high proportion of hospital admissions due to heart failure. Such
admissions are often prolonged and therefore have important budgetary implications for the NHS. The few, relatively small scale, randomised trials of ultrafiltration performed so far have been conducted in healthcare settings very different from the UK, with less fluid retention than is usually seen in UK practice, and where length of stay is usually much shorter than in UK (and European) practice. Although technically feasible, the evidence for benefit on heart failure outcomes is inconsistent and difficult to generalise to UK practice. Therefore a UK-based study of sufficient quality is needed.

Source guidance details

Comes from guidance
Acute heart failure: diagnosis and management
Number
CG187
Date issued
October 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 27/11/2014