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TACTIC-HF: Sequential Diuretic Strategies in Ambulatory Worsening Heart Failure (TACTIC-HF)

11. maj 2026 opdateret af: Lucrecia Maria Burgos

TACTIC-HF: Thiazide or Acetazolamide Combination Versus Intravenous Furosemide in Ambulatory Worsening Heart Failure - a Randomized Crossover Trial

TACTIC-HF is a prospective randomized crossover trial designed to compare three ambulatory diuretic strategies in patients with worsening heart failure treated in a specialized heart failure day-hospital program.

Participants will receive sequential treatment with:

  1. intravenous furosemide alone,
  2. intravenous furosemide combined with oral acetazolamide, and
  3. intravenous furosemide combined with oral hydrochlorothiazide.

The primary objective is to compare short-term natriuretic response between strategies. Secondary objectives include assessment of urine output, congestion parameters, and renal/electrolyte safety.

Each participant will undergo repeated outpatient treatment sessions separated by washout periods, with standardized clinical and laboratory monitoring performed during each visit.

The study aims to evaluate pragmatic and clinically applicable ambulatory decongestion strategies using approved therapies commonly available in real-world practice.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Heart failure congestion remains one of the leading causes of hospitalization and recurrent healthcare utilization worldwide. Although loop diuretics represent the cornerstone of decongestive therapy, many patients develop suboptimal diuretic response or diuretic resistance during the course of chronic heart failure.

Sequential nephron blockade strategies combining loop diuretics with agents acting at different tubular sites may enhance natriuresis and improve decongestion. Recent inpatient studies have suggested potential benefits of acetazolamide- and thiazide-based strategies; however, evidence regarding ambulatory worsening heart failure management remains limited.

TACTIC-HF is a prospective, single-center, randomized, open-label crossover trial evaluating three commonly used outpatient decongestion strategies in patients with worsening heart failure treated in a dedicated heart failure day-hospital setting.

Participants will sequentially receive:

  • intravenous furosemide alone,
  • intravenous furosemide plus oral acetazolamide,
  • intravenous furosemide plus oral hydrochlorothiazide.

Treatments will be administered during structured outpatient sessions with standardized monitoring and predefined washout intervals between treatment periods.

The primary endpoint is total urinary sodium excretion during the treatment session. Secondary endpoints include urine output, congestion-related parameters, and renal/electrolyte safety outcomes.

The study is designed as a pragmatic trial using approved therapies routinely available in clinical practice, with the objective of generating physiologically oriented evidence applicable to ambulatory heart failure care.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

60

Fase

  • Fase 4

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • Age ≥18 years Chronic heart failure diagnosis according to current guideline definitions Ambulatory worsening heart failure requiring intravenous diuretic therapy in a specialized outpatient setting Evidence of clinical or objective congestion Chronic outpatient loop diuretic therapy Ability to comply with study procedures Written informed consent

Exclusion Criteria:

  • Hemodynamic instability or cardiogenic shock Requirement for immediate hospitalization Acute coronary syndrome, active infection, pulmonary embolism, or uncontrolled arrhythmia Severe electrolyte abnormalities Advanced renal failure requiring dialysis Pregnancy or breastfeeding Contraindication or allergy to study medications Current treatment with acetazolamide or thiazide diuretics Any condition that, in the opinion of the investigators, would make study participation unsafe or interfere with study procedures

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Crossover opgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Intravenous Furosemide
Participants receive outpatient intravenous furosemide according to the study protocol during a structured ambulatory treatment session.
Medicin: Intravenous furosemide bolus injections
Intravenous loop diuretic therapy administered during outpatient treatment sessions according to protocol-defined dosing categories.
Eksperimentel: Intravenous Furosemide + Acetazolamide
Participants receive outpatient intravenous furosemide combined with oral acetazolamide during a structured ambulatory treatment session
Medicin: Intravenous furosemide bolus injections
Intravenous loop diuretic therapy administered during outpatient treatment sessions according to protocol-defined dosing categories.
Medicin: ACETAZOLAMIDE oral capsule
Oral acetazolamide administered prior to intravenous loop diuretic therapy during outpatient treatment sessions
Eksperimentel: Intravenous Furosemide + Hydrochlorothiazide
Participants receive outpatient intravenous furosemide combined with oral hydrochlorothiazide during a structured ambulatory treatment session
Medicin: Intravenous furosemide bolus injections
Intravenous loop diuretic therapy administered during outpatient treatment sessions according to protocol-defined dosing categories.
Medicin: Hydrochlorothiazide (HCT)
Oral hydrochlorothiazide administered prior to intravenous loop diuretic therapy during outpatient treatment sessions.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Total Urinary Sodium Excretion at 6 Hours
Tidsramme: 6 hours
Total urine volume collected during the outpatient treatment session
6 hours

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Lucrecia Maria Burgos

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

15. juni 2026

Primær færdiggørelse (Anslået)

15. januar 2027

Studieafslutning (Anslået)

15. januar 2027

Datoer for studieregistrering

Først indsendt

11. maj 2026

Først indsendt, der opfyldte QC-kriterier

11. maj 2026

Først opslået (Faktiske)

18. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

18. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

11. maj 2026

Sidst verificeret

1. maj 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • TACTIC-HF
  • 2 (Instituto Cardiovascular de Buenos Aires)

Plan for individuelle deltagerdata (IPD)

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INGEN

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