Authors' results and conclusions: The relative advantages and disadvantages of ultrafiltration and diuretic therapy have been widely reported in the medical literature, but there is a dearth of information on the population subgroup including only patients who have failed diuretic therapy, and it is unclear what the choice of comparator should be when considering this narrower population. However, in the broader context of the population of heart failure (HF) patients with volume overload, three recent meta-analyses demonstrate that ultrafiltration is associated with significantly greater fluid and/or weight loss compared to diuretic therapy. This literature indicates that neither therapy alone confers a benefit over the alternative in terms of any other patient relevant, HF/fluid overload-specific outcomes. In fact, data on these outcomes were distinctly absent from the meta-analyses described in this Brief update, suggesting these data have not been captured in the wider randomised controlled trial (RCT) literature. Besides reduction in fluid or weight loss, the RCT evidence available to date has concentrated on all-cause mortality and all-cause morbidity; by definition, these outcomes cannot be used to accurately determine differences in mortality and morbidity directly related to fluid overload associated with HF. Definitive conclusions regarding which therapy, ultrafiltration or diuresis, offers the greatest benefit for patients will require an assessment of studies, preferably RCTs, which focus on HF-specific outcomes; at this time, such studies appear to be lacking from the literature comparing the two therapies.

Authors' recommendations: There appears to be insufficient robust evidence from RCTs to support the use of ultrafiltration for the treatment of volume overload in HF patients, with studies to date reporting significant complications. However, some jurisdictions have reported favourable outcomes with this technology and it is slowly diffusing into clinical practice. Although some patients treated with ultrafiltration have experienced earlier discharge and longer periods between readmission, there is a lack of data as to the effect this has on their final outcomes. Therefore, HealthPACT does not support investment of this technology by, nor its introduction into, clinical practice at this time.

Project Status: Completed

Year Published: 2015

URL for published report: Not Available

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)