Volume Overload in Heart Failure

Abstract

Acute decompensated heart failure is the leading cause of hospital admission in the United States, with a high risk of readmission within 30 days. Most acute decompensated heart failure admissions are driven by congestive signs and symptoms resulting from fluid and sodium overload. We reviewed the evidence base addressing the management and prevention of fluid overload in heart failure, focusing on recent clinical trials. All the references in this review were obtained through PubMed and had at least 1 of the following key words: heart failure and volume overload, congestion, loop diuretics, thiazide diuretics, aldosterone antagonists, dopamine, cardiorenal syndrome, nesiritide, vasopressin antagonists, ultrafiltration, sodium restriction, fluid restriction, telemonitoring, and invasive hemodynamic monitoring. We also reviewed relevant references cited in the obtained articles, especially articles addressing methods of treating or preventing volume overload in patients with heart failure.

Neprilysin inhibition: A brief review of past pharmacological strategies for heart failure treatment and future directions

“…The use of diuretic medications has always been — and therefore always will be — a natural component of the drug armamentarium for treating decompensated HF. Diuretics, however, do not address the underlying pathophysiological causes of HF because their perpetual use serves only to augment the RAAS which is the aberrant hormonal cascade of HF [44]. …”

Fluid overload is a determinant for cardiac structural and functional impairments in type 2 diabetes mellitus and chronic kidney disease stage 5 not undergoing dialysis

“…Assessment of fluid overload in patients with DMCKD is important not only for short-term volume management but also for the long-term prevention of cardiovascular disease. This is because fluid overload represents a crucial step in the pathophysiological pathways to chronic heart failure in ESRD patients [ 12 , 13 ]. Therefore, herein, we investigated the impact of actual fluid overload on LVH and LVDD development in patients with diabetes with non-dialysis-dependent CKD stage 5 (CKD5-ND) who were free of intrinsic heart disease.…”

Novel Agent, Sacubitril-Valsartan: Prescribing Patterns and Perceived Barriers to Hospital Formulary Inclusion

“…The New York Heart Association (NYHA) classifies the functional incapacity of patients with cardiac disease into four levels depending on the degree of effort needed to provoke symptoms ( Table 2). The American College of Cardiology Foundation/American Heart Association (ACC/AHA) Task Force on practice guidelines recommend that patients with HF should be routinely treated with a combination of pharmacological agents based on the four development stages (Table 2) [1,[4][5][6][7][8][9][10].…”

“…ACC/AHA stage C classifies a patient with structural heart disease and previous or current HF symptomatology [1]. If clinical evidence of volume overload exists, a diuretic is added [1,[4][5]. In patients with symptomatic heart failure NYHA II-IV and ejection fraction of less than or equal to 35% or reduced ejection fraction after a myocardial infarction, the addition of an aldosterone antagonist is warranted to reduce the risk of hospitalization or death.…”

“…The addition of combination hydralzine/isosorbide to standard therapy has been shown to reduce symptoms and mortality in African Americans with stage C NYHA III-IV heart failure with reduced ejection fraction. Digoxin should only be used together with standard stage C HF therapies in patients with symptomatic HF to reduce hospitalizations, but it only provides symptomatic benefits and does not improve HF survival rate [1,[4][5][6][7]. Pharmacological agents targeting the RAAS have repeatedly shown to achieve HF treatment goals of improved exercise tolerance, functional class, ejection fraction and decrease mortality and hospitalization [10][11][12][13].…”