The relationship between the use of loop diuretics, congestion and heart failure outcome: in search of novel tools of congestion detection and grading

Despite advances in management, the long-term prognosis of heart failure patients remains poor. Fluid accumulation in the human body is called congestion, and the phenomenon is known to attribute significantly to adverse events in the context of heart failure. Congestion is difficult to detect and diuretics – the cornerstone of congestion management – have no high-quality efficacy and safety evidence. Even more, observational data indicates potential harm of diuretic treatment. The present research analyses the complex relationship between congestion, its treatment and heart failure outcome. The results indicate that persistent congestion is deleterious, and treatment with intensive diuretic regimen might be beneficial. Novel tools of congestion detection and grading were identified. All of them have the potential to be translated from the research field to daily clinical practice, after their impact on hard outcome is investigated in appropriate interventional trials.