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Eur J Heart Fail. 2019 Feb;21(2):137-155. doi: 10.1002/ejhf.1369. Epub 2019 Jan 1.

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

Author information

1
Ziekenhuis Oost Limburg, Genk, Belgium.
2
University of Hasselt, Hasselt, Belgium.
3
University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
4
Emergency Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
5
University of Paris Diderot, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, U 942 Inserm, F-CRIN INI-CRCT, Paris, France.
6
Maastricht University Medical Center, Maastricht, The Netherlands.
7
Yale University, New Haven, CT, USA.
8
Cleveland Clinic, Cleveland, OH, USA.
9
University of Florence, Florence, Italy.
10
Université de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT, Nancy, France.
11
University of Brescia, Brescia, Italy.
12
National and Kapodistrian University of Athens, Athens, Greece.
13
University of Cyprus, Nicosia, Cyprus.
14
University of Belgrade, Faculty of Medicine, Belgrade, Serbia.
15
UniversitätsSpital Zürich, Zürich, Switzerland.
16
IRCCS, San Raffaele Pisana, Rome, Italy.

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.

KEYWORDS:

Acute heart failure; Diuretics; Heart failure; Loop diuretics; Pharmacotherapy

PMID:
30600580
DOI:
10.1002/ejhf.1369

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