Combined diuretic treatment in acute heart failure: insights from RICA-2 registry

OBJECTIVE To describe the diuretic strategy used in patients hospitalized for acute heart failure (AHF), as well as to identify the clinical profiles of these patients according to the diuretic regimen received. MATERIALS AND METHODS A multicenter observational study of patients hospitalized for AHF in Internal Medicine departments and included in the Heart Failure Registry (RICA-2). Patients were categorized into three groups based on the diuretic treatment received: intravenous (IV) furosemide alone, IV furosemide plus thiazide diuretics (TD), and IV furosemide plus acetazolamide (ACZ). RESULTS A total of 588 patients were analyzed (median age 84 77-88 years; 51.2% female). IV furosemide alone was administered in 78% of cases, while 22% received combination diuretic therapy (17% with TD and 5% with ACZ). Patients treated with combination diuretics had a higher burden of comorbidities (diabetes, obesity, chronic kidney disease, and renal function impairment at admission), worse NYHA functional class, higher clinical and biochemical markers of congestion, and were more frequently on loop diuretics prior to admission. No significant differences were found in the length of hospital stay according to the diuretic strategy used. Combination diuretic therapy was associated with greater weight loss during hospitalization (3 kg in the TD group and 2.75 kg in the ACZ group) compared to IV furosemide alone (2 kg) (p = 0.005). CONCLUSIONS The most frequently used diuretic strategy in patients hospitalized for AHF in the Internal Medicine departments included in the RICA-2 registry is IV furosemide alone. The combination of diuretics (especially with TD) is more commonly used in patients with more comorbidities and congestion.