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

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 appropri...

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Published inEuropean journal of heart failure Vol. 21; no. 2; pp. 137 - 155
Main Authors Mullens, Wilfried, Damman, Kevin, Harjola, Veli‐Pekka, Mebazaa, Alexandre, Brunner‐La Rocca, Hans‐Peter, Martens, Pieter, Testani, Jeffrey M., Tang, W.H. Wilson, Orso, Francesco, Rossignol, Patrick, Metra, Marco, Filippatos, Gerasimos, Seferovic, Petar M., Ruschitzka, Frank, Coats, Andrew J.
Format Journal Article
LanguageEnglish
Published Oxford, UK John Wiley & Sons, Ltd 01.02.2019
Subjects
Acute heart failure
Cardiology
Consensus
Diuretics
Diuretics - therapeutic use
Europe
Heart failure
Heart Failure - drug therapy
Heart Failure - physiopathology
Humans
Loop diuretics
Pharmacotherapy
Societies, Medical
Stroke Volume - physiology
Europe
Heart failure
Diuretics
Pharmacotherapy
Loop diuretics
Acute heart failure
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ISSN1388-9842
1879-0844
1879-0844
DOI10.1002/ejhf.1369

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Summary: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.
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ISSN:1388-9842
1879-0844
1879-0844
DOI:10.1002/ejhf.1369