Loop diuretics in chronic heart failure: how to manage congestion?

Justas Simonavicius*, Christian Knackstedt, Hans-Peter Brunner-La Rocca

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Web of Science)

Abstract

Loop diuretics remain the cornerstone of congestion management in contemporary chronic heart failure care. However, their use is not supported by high quality data, and there is doubt about the safety in the outpatient heart failure setting. Still, congestion is related to a worse outcome, and there is general consensus among experts that congestion should not be tolerated in heart failure patients. Recommendations in international guidelines, regarding decongestion strategies in chronic heart failure, are limited. Thus, there is an emerging need for clinical decision-making support about the best strategy for using loop diuretics and decongestion in the chronic setting. The present review provides a comprehensive overview over the evidence of chronic loop diuretic use. Strategies for the assessment of congestion in the outpatient setting and decongestion algorithm are provided to assist health care specialists in delivering high-quality heart failure care.

Original languageEnglish
Pages (from-to)17-30
Number of pages14
JournalHeart Failure Reviews
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • 2013 ACCF/AHA GUIDELINE
  • ADVERSE OUTCOMES
  • AMERICAN-COLLEGE
  • ASSOCIATION TASK-FORCE
  • Chronic heart failure
  • Decongestion
  • Diuretic resistance
  • Diuretic therapy
  • ELDERLY-PATIENTS
  • EUROPEAN-SOCIETY
  • FUROSEMIDE WITHDRAWAL
  • JAPANESE CARDIAC REGISTRY
  • Loop diuretic
  • PULMONARY-ARTERY PRESSURE
  • Volume overload
  • WORSENING RENAL-FUNCTION
  • LUNG ULTRASOUND

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