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


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 (2019). The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 21(2):137-155.

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.

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.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 February 2019
Deposited On:18 Jan 2019 14:59
Last Modified:15 Feb 2019 02:05
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1388-9842
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1002/ejhf.1369
PubMed ID:30600580

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