The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology

Wilfried Mullens*, Kevin Damman, Veli-Pekka Harjola, Alexandre Mebazaa, Hans-Peter Brunner-La Rocca, Pieter Martens, Jeffrey M. Testani, W. H. Wilson Tang, Francesco Orso, Patrick Rossignol, Marco Metra, Gerasimos Filippatos, Petar M. Seferovic, Frank Ruschitzka, Andrew J. Coats

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.

Original languageEnglish
Pages (from-to)137-155
Number of pages19
JournalEuropean journal of heart failure
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Diuretics
  • Heart failure
  • Acute heart failure
  • Pharmacotherapy
  • Loop diuretics
  • REDUCED EJECTION FRACTION
  • RENAL-FUNCTION
  • PROGNOSTIC VALUE
  • NATRIURETIC RESPONSE
  • LUNG ULTRASOUND
  • VENOUS-PRESSURE
  • LOOP DIURETICS
  • AGGRESSIVE DECONGESTION
  • INTRAVENOUS FUROSEMIDE
  • PULMONARY CONGESTION

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