[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100629059":3},{"organization":4,"armGroups":7,"interventions":23,"overallOfficials":49,"centralContacts":54,"locations":60,"responsibleParty":75,"collaborators":29,"id":77,"slug":78,"hasResults":79,"nctId":80,"briefTitle":81,"officialTitle":82,"acronym":83,"eligibilityCriteria":84,"healthyVolunteers":79,"sex":85,"minAge":86,"maxAge":29,"enrollmentInfo":87,"targetDuration":29,"studyType":90,"phases":91,"briefSummary":94,"conditions":95,"keywords":102,"overallStatus":109,"whyStopped":29,"lastUpdateSubmitDate":110,"lastUpdatePostDateStruct":111,"startDateStruct":114,"completionDateStruct":116,"leadSponsor":118,"locationsCount":119},{"fullName":5,"class":6},"Hospital de Clinicas de Porto Alegre","OTHER",[8,15],{"label":9,"type":10,"description":11,"interventionNames":12},"Standard of care","ACTIVE_COMPARATOR","Standard of care with additional information from the EVEREST congestion score and guideline-based treatment recommendations.\n\nDiuretics will be administered intravenously according to the institutional standard of care, with results from the EVEREST congestion score assessment and guideline-based treatment recommendations provided to the treating medical team. Dapagliflozin will also be suggested as part of guideline-directed medical therapy for patients without contraindications.",[13,14],"Drug: Furosemide 40 Milligrams.","Drug: Dapagliflozin (10mg Tab)",{"label":16,"type":17,"description":18,"interventionNames":19},"Diuretic therapy guided by DUCS-based POCUS","EXPERIMENTAL","Treatment recommendation will be made according to baseline DUCS-based POCUS assessment, as follows:\n\nPatients with DUCS 2-4 points (defined as mild to moderate congestion): the recommended intravenous loop diuretic dose will be twice the patient's previous total daily oral dose. If no diuretics were taken previously, intravenous furosemide 40 mg three times daily will be administered.\n\nPatients with DUCS ≥ 5 points (defined as severe congestion): the recommended intravenous loop diuretic dose will be twice the patient's previous total daily oral dose. If no diuretics were taken previously, intravenous furosemide 40 mg three times daily will be administered. Addition of a second diuretic will be recommended, either oral hydrochlorothiazide or oral acetazolamide, according to serum electrolyte levels.\n\nSerial DUCS-based POCUS assessments will provide recommendations for diuretic therapy adjustments.\n\nDapagliflozin and oral potassium supplements will also be suggested if appropriate.",[13,20,21,14,22],"Drug: Hydrochlorothiazide (HCTZ) 25 milligrams.","Drug: Acetazolamide 250 milligrams.","Drug: Potassium Chloride Oral Product",[24,30,33,37,41,45],{"type":25,"name":26,"description":27,"armGroupLabels":28,"otherNames":29},"DRUG","Furosemide 40 Milligrams.","Decongestive therapy with intravenous furosemide, with or without oral hydrochlorothiazide and\u002For oral acetazolamide, will be adjusted based on DUCS-based POCUS assessments.\n\nProcedure: DUCS-based POCUS protocol DUCS ranges from 0 to 10 points and is divided into three categories: absence of congestion (\\\u003C2 points), mild to moderate congestion (2-4 points) and severe congestion (≥5 points). DUCS integrates eight-zone lung ultrasound (each zone considered positive in the presence of ≥3 B-lines) and modified VExUS (inferior vena cava, portal vein and hepatic vein Doppler) assessments. For lung ultrasound, 2-3 positive zones score 2 points, 4-5 score 4 points and ≥6 score 5 points. For modified VExUS, grade 1 scores 1 point, grade 2 scores 2 points, and grade 3 scores 5 points. The final DUCS value is calculated as the sum of both components.",[16],null,{"type":25,"name":26,"description":31,"armGroupLabels":32,"otherNames":29},"Procedure: physical examination according to the EVEREST congestion score and guideline-based treatment recommendations.\n\nResults from the physical examination will be provided to the medical team in the form of the EVEREST composite congestion score (CCS), which ranges from 0 to 9 and incorporates evaluation of jugular venous distension, pedal edema, and orthopnea.\n\nGeneral guideline-based recommendations for the management of ADHF will be provided to the medical team.",[9],{"type":25,"name":34,"description":35,"armGroupLabels":36,"otherNames":29},"Hydrochlorothiazide (HCTZ) 25 milligrams.","Addition of a second diuretic will be recommended, either oral hydrochlorothiazide or oral acetazolamide, according to serum potassium and bicarbonate levels. Hydrochlorothiazide dose will be defined according to serum creatinine and estimated glomerular filtration rate (eGFR).",[16],{"type":25,"name":38,"description":39,"armGroupLabels":40,"otherNames":29},"Acetazolamide 250 milligrams.","Addition of a second diuretic will be recommended, either oral hydrochlorothiazide or oral acetazolamide, according to serum potassium, serum bicarbonate, and estimated glomerular filtration rate (eGFR).",[16],{"type":25,"name":42,"description":43,"armGroupLabels":44,"otherNames":29},"Dapagliflozin (10mg Tab)","Dapagliflozin will be suggested to the treating medical team as part of guideline-directed medical therapy for patients without contraindications.",[16,9],{"type":25,"name":46,"description":47,"armGroupLabels":48,"otherNames":29},"Potassium Chloride Oral Product","Oral potassium chloride supplementation will be administered to patients with serum potassium \\\u003C 4.0 mEq\u002FL in the experimental group.",[16],[50],{"name":51,"affiliation":52,"role":53},"Luis E Rohde, Professor","Hospital de Clínicas de Porto Alegre","STUDY_CHAIR",[55],{"name":56,"role":57,"phone":58,"phoneExt":29,"email":59},"Henrique C Scherer, MD","CONTACT","5551 33596246","henriquecscherer@gmail.com",[61],{"facility":52,"status":29,"city":62,"state":63,"zip":64,"country":65,"countryCode":66,"cosmosGeoPoint":67,"geoPoint":72,"contacts":73},"Porto Alegre","Rio Grande do Sul","90410-000","Brazil","BR",{"type":68,"coordinates":69},"Point",[70,71],-51.23019,-30.03283,{"lat":71,"lon":70},[74],{"name":56,"role":57,"phone":58,"phoneExt":29,"email":59},{"type":76,"investigatorFullName":29,"investigatorTitle":29,"investigatorAffiliation":29,"oldNameTitle":29,"oldOrganization":29},"SPONSOR","100629059","phase-2-pocus-intervention-for-tailoring-diuretic-strategy-in-acute-decompensated-heart-failure-100629059",false,"NCT07469722","POcus INTERvention for Tailoring Diuretic Strategy in Acute Decompensated Heart Failure","Point-of-care Ultrasound Intervention for Tailoring Diuretic Strategy in Acute Decompensated Heart Failure","POINTER-HF","Inclusion Criteria:\n\n* Men or women aged 18 years or older.\n* Diagnosis of acute decompensated heart failure (ADHF) with left ventricular ejection fraction \\\u003C50%, presenting with symptoms (dyspnea, orthopnea, fatigue) and\u002For signs (pulmonary crackles, peripheral edema, jugular venous distension, hepatomegaly, hepatojugular reflux) of decompensated heart failure.\n* Brain natriuretic peptide (BNP) ≥ 300 pg\u002FmL.\n* Signs of systemic and\u002For pulmonary congestion on POCUS, defined as DUCS ≥ 3 points.\n* Time from hospital admission ≤ 48 hours.\n* Signed informed consent.\n\nExclusion Criteria:\n\n* Patients under evaluation for heart transplantation or with prior heart transplantation.\n* Acute coronary syndrome as the primary cause of hospitalization.\n* Evidence of uncontrolled infection.\n* Cardiac surgery or percutaneous coronary or structural cardiac intervention within the previous 30 days.\n* Signs of hypoperfusion, defined as any of the following: mean arterial pressure \\\u003C 60 mmHg, capillary refill time \\> 4 seconds, arterial lactate \\> 2 mmol\u002FL or venous lactate \\> 2.5 mmol\u002FL.\n* Acute pulmonary embolism (segmental or more proximal) as the primary cause of hospitalization.\n* Acute stroke.\n* Chronic kidney disease stage 5 (estimated glomerular filtration rate \\\u003C 15 ml\u002Fmin\u002Fm²) or requirement for renal replacement therapy.\n* Liver cirrhosis with portal hypertension.\n* Known pulmonary disease with extensive parenchymal involvement, including interstitial lung disease, pulmonary metastases, prior pneumonectomy, lobectomy, or pleurodesis.\n* Severe hypokalemia (serum potassium \\\u003C 2.5 mmol\u002FL).\n* Pregnancy or breastfeeding.\n* Refusal to participate in the clinical trial.","ALL","18 Years",{"count":88,"type":89},128,"ESTIMATED","INTERVENTIONAL",[92,93],"PHASE2","PHASE3","Acute decompensated heart failure (ADHF) is a frequent cause of hospitalization and is associated with high morbidity and mortality. Congestion is the primary pathophysiological mechanism leading to clinical deterioration and hospitalization in ADHF. Diuretics remain the cornerstone of treatment for most ADHF phenotypes; however, evidence regarding optimal strategies to guide diuretic therapy during the decongestion process is limited. Recently, point-of-care ultrasound (POCUS) has emerged as a promising tool to support clinical assessment in ADHF, improving diagnostic accuracy, prognostication, and pre-discharge evaluation. Nevertheless, the role of POCUS in guiding therapeutic management in ADHF remains uncertain. To specifically assess congestion in patients with ADHF, a pragmatic POCUS-based score, the Dynamic Ultrasound Congestion Score (DUCS), was developed. DUCS integrates lung ultrasound and Venous Excess Ultrasound (VExUS) to dynamically evaluate congestion severity, treatment response, and therapeutic goals during ADHF management. Observational data suggest that DUCS is associated with in-hospital outcomes and short-term prognosis, and correlates with markers of decongestion such as urinary output and weight loss. This study is a randomized, single-center, single-blind clinical trial designed to evaluate whether a DUCS-guided POCUS strategy improves clinical and decongestion outcomes compared with standard of care. Eligible patients hospitalized due to ADHF will be randomized within 48 hours of admission to one of two groups: (1) diuretic treatment guided by institutional standard-of-care combined with information from the EVEREST congestion score assessment and guideline-based treatment recommendations; or (2) diuretic treatment guided by serial DUCS-based POCUS assessments used to inform diuretic adjustment recommendations. Participants in both groups will undergo evaluations at baseline (day 1), day 2, day 3 and day 5, including clinical data collection, physical examination using the EVEREST congestion score, and standardized DUCS-based POCUS assessments. Outcomes to be assessed include in-hospital mortality, length of hospital stay, decongestion parameters, and changes in biomarkers.",[96,97,98,99,100,101],"Acute Heart Failure (AHF)","Congestive Heart Failure Acute","Diuretic Effect","Lung Ultrasonography Score","Ultrasonography, Doppler","Point-of-care Ultrasound (POCUS)",[103,104,105,106,107,108],"Acute Heart Failure","Congestive Heart Failure","Point-of-Care Ultrasound","Lung Ultrasound","Venous Excess Ultrasound","Diuretic","NOT_YET_RECRUITING","2026-03-16",{"date":112,"type":113},"2026-03-18","ACTUAL",{"date":115,"type":89},"2026-03-23",{"date":117,"type":89},"2028-07-01",{"name":5,"class":6},1]