2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

Ponikowski, Piotr; Voors, Adriaan A.; Anker, Stefan D.; Bueno, Héctor; Cleland, John G.F.; Coats, Andrew J.S.; Falk, Volkmar; González-Juanàtey, José Ramón; Harjola, Veli‐Pekka; Jankowska, Ewa A.; Jessup, Mariell; Linde, Cecilia; Nihoyannopoulos, Petros; Parissis, John; Pieske, Burkert; Riley, Jillian; Rosano, Giuseppe; Ruilope, Luís M.; Ruschitzka, Frank; Rutten, Frans H.; Meer, Peter van der

doi:10.1016/j.rec.2016.11.005

Cited by 562 publications

(782 citation statements)

References 228 publications

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“…Intravenous loop diuretics form the mainstay of decongestive therapy, but unfortunately, resistance to these agents is common 3. Both US and European Heart Failure (HF) guidelines state that when diuresis remains inadequate with loop diuretic therapy, either escalation of loop diuretic dose or the addition of a thiazide diuretic may be considered to intensify the regimen, yet these recommendation are based on limited data to support the relative safety of each appraoch 4, 5, 6. Notably, sequential nephron blockade further limits the ability of the kidney to regulate fluid and electrolyte excretion beyond loop diuretic monotherapy, potentially leading to complications such as hyponatremia, hypokalemia, and worsening renal function (WRF) 7, 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Brisco‐Bacik

Maaten

Houser

et al. 2018

JAHA

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BackgroundIn acute decompensated heart failure, guidelines recommend increasing loop diuretic dose or adding a thiazide diuretic when diuresis is inadequate. We set out to determine the adverse events associated with a diuretic strategy relying on metolazone or high‐dose loop diuretics.Methods and ResultsPatients admitted to 3 hospitals using a common electronic medical record with a heart failure discharge diagnosis who received intravenous loop diuretics were studied in a propensity‐adjusted analysis of all‐cause mortality. Secondary outcomes included hyponatremia (sodium <135 mEq/L), hypokalemia (potassium <3.5 mEq/L) and worsening renal function (a ≥20% decrease in estimated glomerular filtration rate). Of 13 898 admissions, 1048 (7.5%) used adjuvant metolazone. Metolazone was strongly associated with hyponatremia, hypokalemia, and worsening renal function (P<0.0001 for all) with minimal effect attenuation following covariate and propensity adjustment. Metolazone remained associated with increased mortality after multivariate and propensity adjustment (hazard ratio=1.20, 95% confidence interval 1.04–1.39, P=0.01). High‐dose loop diuretics were associated with hypokalemia and hyponatremia (P<0.002) but only worsening renal function retained significance (P<0.001) after propensity adjustment. High‐dose loop diuretics were not associated with reduced survival after multivariate and propensity adjustment (hazard ratio=0.97 per 100 mg of IV furosemide, 95% confidence interval 0.90–1.06, P=0.52).ConclusionsDuring acute decompensated heart failure, metolazone was independently associated with hypokalemia, hyponatremia, worsening renal function and increased mortality after controlling for the propensity to receive metolazone and baseline characteristics. However, under the same experimental conditions, high‐dose loop diuretics were not associated with hypokalemia, hyponatremia, or reduced survival. The current findings suggest that until randomized control trial data prove otherwise, uptitration of loop diuretics may be a preferred strategy over routine early addition of thiazide type diuretics when diuresis is inadequate.

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Section: Introductionmentioning

confidence: 99%

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Brisco‐Bacik

Maaten

Houser

et al. 2018

JAHA

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“…UF is not recommended for routine treatment by the cardiac failure guidelines, and is recommended for a group of patients unresponsive to diuretic therapy or for those with resistant volume loading (1).…”

Section: In Which Patient Group Peritoneal Ultrafiltration May Be Recmentioning

confidence: 99%

“…According to the classification by ejection fraction (EF) in current cardiology guidelines, an EF of ≥50% is defined as HF with preserved EF, an EF <40% as HF with reduced EF, and an EF between 40-49% is classified as "grey zone" (1).…”

Section: Introductionmentioning

confidence: 99%

Role of Peritoneal Ultrafiltration in Heart Failure Treatment

Senel¹,

Cebeci²,

Öztürk³

2017

Haseki

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“…Consequently, sacubitril/valsartan has already been incorporated into management guidelinesbut at different steps. [4][5][6][7] The guidance could hardly be more favourable. NICE recommends sacubitril/valsartan as an option for people with chronic heart failure and reduced ejection fraction (≤35 per cent) who have NYHA class II-IV symptoms, despite stable treatment with an ACE inhibitor or an angiotensin II-receptor antagonist.…”

Section: Place In Therapymentioning

confidence: 99%

“…Drug treatment focuses on symptom relief and has not been shown to reduce mortality, morbidity or improve exercise intolerance. 5 *Kansas City Cardiomyopathy Questionnaire (KCCQ) score (on a scale from 0 to 100, with higher scores indicating fewer symptoms and physical limitations associated with heart failure); data are least-squares mean ± standard error of the between group difference **Defined as end-stage renal disease or as a decrease in the estimated glomerular filtration rate (eGFR) of ≥50 per cent or a decrease of >30ml/min/1.73m 2 from randomisation to <60ml/min/1.73m 2 Table 2. Primary and secondary outcomes in the PARADIGM-HF trial, comparing sacubitril/valsartan and enalapril in patients with symptoms of heart failure 1 cardiovascular death and hospitalisation for heart failure when added to standard care (excluding ACE inhibitors and angiotensin II-receptor antagonists) in patients with preserved ejection fraction.…”

Section: Uptake So Farmentioning

confidence: 99%