Inpatient Diuretic Management of Acute Heart Failure: A Practical Review

Ali, Saif; Jung, Sharon; Nandkeolyar, Shuktika; Stoletniy, Liset; Sakr, Antoine; Verbrugge, Frederik H.; Hilliard, Anthony; Abramov, Dmitry

doi:10.1007/s40256-020-00463-5

Cited by 5 publications

(6 citation statements)

References 111 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the increased risk of WRF could not be dismissed. Furthermore, the high cost of tolvaptan may also limit its clinical utility [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trial registries ( ) were searched for AHF trials associated with the use of adjuvants to diuretics to retrieve relevant studies. The reference lists of recent relevant reviews [ 19 , 20 , 21 , 22 ] were searched to ensure literature saturation. The search strategy included MeSH terms and the keywords “acute heart failure” or “cardiac failure” or “acute decompensated heart failure” AND “decongestion” OR “diuresis” OR “dyspnea”.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials

Emara

Mansour

Elnaem

et al. 2022

JCM

View full text Add to dashboard Cite

Diuretic therapy is the mainstay during episodes of acute heart failure (AHF). Diuretic resistance is often encountered and poses a substantial challenge for clinicians. There is a lack of evidence on the optimal strategies to tackle this problem. This review aimed to compare the outcomes associated with congestion management based on a strategy of pharmacological nondiuretic-based regimens. The PubMed, Cochrane Library, Scopus, and ScienceDirect databases were systematically searched for all randomised controlled trials (RCTs) of adjuvant pharmacological treatments used during hospitalisation episodes of AHF patients. Congestion relief constitutes the main target in AHF; hence, only studies with efficacy indicators related to decongestion enhancement were included. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included RCTs. Twenty-three studies were included; dyspnea relief constituted the critical efficacy endpoint in most included studies. However, substantial variations in dyspnea measurement were found. Tolvaptan and serelaxin were found to be promising options that might improve decongestion in AHF patients. However, further high-quality RCTs using a standardised approach to diuretic management, including dosing and monitoring strategies, are crucial to provide new insights and recommendations for managing heart failure in acute settings.

show abstract

“…However, the increased risk of WRF could not be dismissed. Furthermore, the high cost of tolvaptan may also limit its clinical utility [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials

Emara

Mansour

Elnaem

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…The effectiveness of loop diuretics in reducing mortality and hospitalization rates has been confirmed in many non-randomized studies, most recently in the analysis of the OPTIMIZE-HF registry [19]. Depending on the mechanism of action and the gripping point, diuretic drugs can be divided into several classes, shown in Figure 2 (modified according to [20]).…”

Section: Diureticsmentioning

confidence: 97%

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

et al. 2023

View full text Add to dashboard Cite

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021-2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect -options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers -carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio-and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed.

show abstract

“…The postdiuretic effect caused by rebound Na and water retention during intervals between dosing can be countered by increasing the dosing frequency or using loop diuretics with longer half‐lives, such as torsemide 81 . In the case of intrarenal causes of resistance, such as distal tubular hypertrophy, sequential nephron blockade using distal tubule‐specific drugs such as hydrochlorothiazide or spironolactone, or proximal tubule‐specific drugs, such as acetazolamide, might be particularly effective at restoring responsiveness 74,82 . Another potential benefit of objectively measuring diuretic responsiveness is the ability to assess utility of changes in treatment or in patient status without dependence on the presence of clinical signs.…”

Section: Strategies To Address Diuretic Resistancementioning

confidence: 99%

“… 81 In the case of intrarenal causes of resistance, such as distal tubular hypertrophy, sequential nephron blockade using distal tubule‐specific drugs such as hydrochlorothiazide or spironolactone, or proximal tubule‐specific drugs, such as acetazolamide, might be particularly effective at restoring responsiveness. 74 , 82 Another potential benefit of objectively measuring diuretic responsiveness is the ability to assess utility of changes in treatment or in patient status without dependence on the presence of clinical signs. For instance, serial measurements of uNa in patients being treated for chronic CHF might detect gradual loss of diuretic efficacy that can be addressed before an episode of congestion occurs.…”

Section: Strategies To Address Diuretic Resistancementioning

confidence: 99%

Toward quantification of loop diuretic responsiveness for congestive heart failure

Oyama

Adin

2022

Veterinary Internal Medicne

View full text Add to dashboard Cite

Diuretics, such as furosemide, are routinely administered to dogs with congestive heart failure (CHF). Traditionally, dose and determination of efficacy primarily are based on clinical signs rather than quantitative measures of drug action. Treatment of human CHF patients increasingly is guided by quantification of urine sodium concentration (uNa) and urine volume after diuretic administration. Use of these and other measures of diuretic responsiveness is associated with decreased duration of hospitalization, complication rates, future rehospitalization, and mortality. At their core, loop diuretics act through natriuresis, and attention to body sodium (Na) stores and handling offers insight into the pathophysiology of CHF and pharmacology of diuretics beyond what is achievable from clinical signs alone. Human patients with low diuretic responsiveness or diuretic resistance are at risk for difficult or incomplete decongestion that requires diuretic intensification or other remedial strategies. Identification of the specific etiology of resistance in a patient can help tailor personalized interventions.In this review, we advance the concept of loop diuretic responsiveness by highlighting Na and natriuresis. Specifically, we review body water homeostasis and congestion in light of the increasingly recognized role of interstitial Na, propose definitions for diuretic responsiveness and resistance in veterinary subjects, review relevant findings of recent studies, explain how the particular cause of resistance can guide treatment, and identify current knowledge gaps. We believe that a quantitative approach to loop diuretic usage primarily involving natriuresis will advance our understanding and care of dogs with CHF.

show abstract

Inpatient Diuretic Management of Acute Heart Failure: A Practical Review

Cited by 5 publications

References 111 publications

Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials

Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

Toward quantification of loop diuretic responsiveness for congestive heart failure

Contact Info

Product

Resources

About