Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Catlin, James; Adams, C. B. T.; Louie, Daniel; Wilson, Machelle; Louie, Erin N.

doi:10.1177/1060028017725763

Cited by 6 publications

(1 citation statement)

References 13 publications

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“…We read with great interest the study by Catlin et al 1 on 91 patients with acute decompensated heart failure (ADHF), which concluded that aggressive initial diuretic therapy in the emergency department is associated with improved outcomes compared with conservative dosing. It is well known that congestion is the primary reason for hospitalization of patients with ADHF, and adequate decongestion is associated with improved outcomes in these patients.…”

Section: Letter To the Editormentioning

confidence: 99%

Comment: Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Koratala

Kazory

2017

Ann Pharmacother

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Section: Letter To the Editormentioning

confidence: 99%

Comment: Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Koratala

Kazory

2017

Ann Pharmacother

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The Art and Science of Using Diuretics in the Treatment of Heart Failure in Diverse Clinical Settings

Islam

2018

Advances in Experimental Medicine and Biology

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It is important to understand the rationale for appropriate use of different diuretics, alone or in combination, in different heart failure patients, under diverse clinical settings. Clinicians and nurses engaged in heart failure care, must be familiar with different diuretics, their appropriate doses, methods of administration, monitoring of the responses, and the side-effects. Inappropriate use of diuretics, both under-treatment and overtreatment, and poor follow-up can lead to failures, and adverse outcomes. Adequate treatment of congestion, with rather aggressive use of diuretics, is necessary, even if that may worsen renal function temporarily in some patients. Diuretic treatment should later be titrated down, by early recognition of the euvolemic sate, which can be assessed by clinical examination, measurement of the natriuretic peptides, and when possible, echocardiographic estimation of the left ventricular filling pressure. You need to treat patients, who are truly resistant to the loop diuretics, by administering the diuretics as intravenous bolus injection followed by continuous infusion, and/or by sequential nephron blockade by adding the thiazide diuretics. You need to use the diuretics based on a sound understanding of the pathophysiology of the disease process, the pharmacokinetics and pharmacodynamics of the diuretics, even when strong evidences for your choices might be lacking. Some patients may benefit from injection of loop diuretics together with hypertonic saline, and others from injection of loop diuretics with albumin. Patient education, and regular follow up of the treatment of heart failure patients, in out-patient settings are important for reducing the rates of complications, and for reducing the needs for urgent hospitalizations.

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Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?

Bielecka‐Dąbrowa

Godoy

Schefold

et al. 2018

Curr Heart Fail Rep

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One of the strongest predictors of adverse outcomes in ADHF is renal dysfunction, referred to as cardiorenal syndromes (CRS) or cardiorenal interactions. Patients with ADHF frequently develop worsening of renal function (WRF) and/or acute kidney injury (AKI). Recent studies brought new information about biomarkers in diagnosing and predicting prognosis of CRS. Among others, dry weight at hospital discharge is considered a surrogate marker of successful treatment in ADHF patients with/without renal dysfunction. The etiology of WRF appears to be an important factor for determining risk related to WRF as well as clinical management. The hypertonic saline used as adjunctive therapy for intravenous loop diuretics and/or induction of aquaresis (e.g., using tolvaptan) may be promising and efficient approaches in the future.

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Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Abstract: Patients who received an aggressive initial diuretic dose in the ED had a significantly faster time to oral diuretic therapy without any significant differences in hospital LOS, urine output, change in body weight, and renal function when compared with conservative dosing.

Cited by 6 publications

References 13 publications

Comment: Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Comment: Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

The Art and Science of Using Diuretics in the Treatment of Heart Failure in Diverse Clinical Settings

Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?

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