Diuretics for heart failure

Faris, R; Flather, MD; Purcell, Henry; Heinan, MY; Poole‐Wilson, P.A.; Coats, A.J.S.

doi:10.1002/14651858.cd003838

Cited by 31 publications

(42 citation statements)

References 23 publications

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“…GRADE: Strong; Evidence: High. A diuretic should be considered in patients with HF and clinical symptoms, or signs of congestion, to improve symptoms and manage congestion 20 . GRADE: Strong; Evidence: Very low.…”

Section: Methodsmentioning

confidence: 99%

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018

Atherton

Sindone

Pasquale

et al. 2018

Medical Journal of Australia

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Introduction: Heart failure (HF) is a clinical syndrome that is secondary to an abnormality of cardiac structure or function. These clinical practice guidelines focus on the diagnosis and management of HF with recommendations that have been graded on the strength of evidence and the likely absolute benefit versus harm. Additional considerations are presented as practice points. Main recommendations: Blood pressure and lipid lowering decrease the risk of developing HF. Sodium–glucose cotransporter 2 inhibitors decrease the risk of HF hospitalisation in patients with type 2 diabetes and cardiovascular disease. An echocardiogram is recommended if HF is suspected or newly diagnosed. If an echocardiogram cannot be arranged in a timely fashion, measurement of plasma B‐type natriuretic peptides improves diagnostic accuracy. Angiotensin‐converting enzyme inhibitors, β‐blockers and mineralocorticoid receptor antagonists improve outcomes in patients with HF associated with a reduced left ventricular ejection fraction. Additional treatment options in selected patients with persistent HF associated with reduced left ventricular ejection fraction include switching the angiotensin‐converting enzyme inhibitor to an angiotensin receptor neprilysin inhibitor; ivabradine; implantable cardioverter defibrillators; cardiac resynchronisation therapy; and atrial fibrillation ablation. Multidisciplinary HF disease management facilitates the implementation of evidence‐based HF therapies. Clinicians should also consider models of care that optimise medication titration (eg, nurse‐led titration). Changes in management as a result of the guideline: These guidelines have been designed to facilitate the systematic integration of recommendations into HF care. This should include ongoing audit and feedback systems integrated into work practices in order to improve the quality of care and outcomes of patients with HF.

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Section: Methodsmentioning

confidence: 99%

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018

Atherton

Sindone

Pasquale

et al. 2018

Medical Journal of Australia

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“…Loop diuretics are an essential component of symptom relief in congestive HF, although their impact on the course of chronic HF is less well demonstrated than for neurohormonal blockade 48. Clinical evidence suggests that torasemide improved ventricular function and clinical outcomes beyond what is observed with furosemide, despite similar renal effects, and despite a more pronounced stimulation of the RAAS by torasemide 9.…”

Section: Myocardial Fibrosis As a Therapeutic Target For Loop Diuretimentioning

confidence: 99%

Molecular targets of current and prospective heart failure therapies

Chemaly

Hajjar

Lipskaia

2013

Heart

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Heart failure (HF) is a vicious circle in which an original insult leading to mechanical cardiac dysfunction initiates multiple morphological, biochemical and molecular pathological alterations referred to as cardiac remodelling. Remodelling leads to further deterioration of cardiac function and functional reserve. Interrupting or reversing cardiac remodelling is a major therapeutic goal of HF therapies. The role of molecules and molecular pathways in cardiac remodelling and HF has been extensively studied. Multiple approaches are now used or investigated in HF therapy, including pharmacological therapy, device therapy, gene therapy, cell therapy and biological therapy targeting cytokines and growth factors. This review explores the molecular targets and molecular bases of current and prospective therapies in HF.

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“…The number of readmissions related to heart failure can be reduced by proper management of fluid retention [2]. Meta-analysis revealed that diuretic-based treatment, compared with placebo, could decrease hospitalizations for worsening of heart failure, as part of symptomatic treatment [3, 4]. Current guidelines do not emphasize superiority of any of the available diuretics [1].…”

Section: Introductionmentioning

confidence: 99%

The impact of torasemide on haemodynamic and neurohormonal stress, and cardiac remodelling in heart failure – TORNADO: a study protocol for a randomized controlled trial

Balsam

Ozierański

Tymińska

et al. 2017

Trials

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BackgroundApproximately 50% of heart failure patients are readmitted to hospital within 6 months, owing to deterioration of their condition. Thus, symptomatic treatment of heart failure requires significant improvement. The aim of this study is to compare the effects of torasemide and furosemide on biochemical parameters of haemodynamic and neurohormonal compensation, myocardial remodelling, clinical outcomes and quality of life in patients with chronic heart failure.MethodsThis is a multicentre, randomized, open, blinded endpoint phase-IV trial. The study includes 120 heart failure patients in NYHA (New York Heart Association) functional class II–IV, treated with optimal heart failure therapy, with indications for use of loop diuretics. At enrolment, patients are stable, with a fixed dose of loop diuretics. Patients are randomized to treatment with furosemide or torasemide (randomization 1:1). After randomization, the current fixed dose of furosemide is continued or is replaced by an equipotential dose of torasemide (4:1). The study consists of two control visits (3 and 6 months after enrolment) with minimal follow-up of 6 months. Assessment involves clinical examination, Quality of Life Questionnaire, laboratory tests, echocardiography, electrocardiography, 24 h Holter-electrocardiography monitoring, 6 -min walk test and assessment of fluid retention. Any need for dose adjustment is assessed during the observation. The primary objective is to compare the effects of torasemide and furosemide on clinical and biochemical parameters of haemodynamic and neurohormonal compensation and myocardial remodelling. Secondary objectives include monitoring of: changes in signs and symptoms of heart failure, NYHA functional class, quality of life, dosage changes, rate of readmissions and mortality.DiscussionDespite decades of the diuretic’s history, knowledge about diuretic therapy is still unsatisfactory. The most widely used diuretic, furosemide, has a stormy pharmacokinetics and pharmacodynamics, and is associated with a high risk of mortality and hospitalization for worsening heart failure. Reports are very encouraging and suggest beneficial effects of torasemide. Hence, there is a need for further studies of the overall effect of torasemide, compared with furosemide. This can translate into improved quality of life and better prognosis of patients with heart failure.Trial registrationClinicalTrials.gov, NCT01942109. Registered on 24 August 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1760-z) contains supplementary material, which is available to authorized users.

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Diuretics for heart failure

Cited by 31 publications

References 23 publications

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018

Molecular targets of current and prospective heart failure therapies

The impact of torasemide on haemodynamic and neurohormonal stress, and cardiac remodelling in heart failure – TORNADO: a study protocol for a randomized controlled trial

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