Enhanced decongestion with second-line diuretics should be reserved for acute heart failure patients unresponsive to loop diuretics, with a primary focus on rapid GDMT uptitration.
For most patients with acute heart failure, the primary focus should be rapid uptitration of guideline-directed medical therapy, reserving enhanced decongestion for those who do not respond to loop diuretics.
Because signs of congestion are associated with adverse outcomes in patients with acute heart failure (AHF), attempts were made to decongest patients as much as possible with diuretic agents (loop diuretic agents, thiazides, acetazolamide) or mechanical devices. Those interventions improved signs of congestion but failed to meaningfully improve patients' symptoms, improve quality of life, or reduce early readmissions or deaths. Recent studies have shown that implementation of guideline-directed medical therapies after an AHF admission led to both more decongestion and improved symptoms, quality of life, and outcomes. Therefore, for most patients with AHF whose symptoms and congestion can be controlled with loop diuretic agents, the main focus should be rapid guideline-directed medical therapy uptitration. Enhanced decongestion, ie, adding a second-line diuretic agent to a loop diuretic agent, should be reserved for those patients who do not respond to loop diuretic agents.
Cotter et al. (Mon,) conducted a review in Acute Heart Failure. Enhanced decongestive therapy was evaluated. Enhanced decongestion with second-line diuretics should be reserved for acute heart failure patients unresponsive to loop diuretics, with a primary focus on rapid GDMT uptitration.