Do combination diuretic strategies improve clinical outcomes and decongestion in patients with acute heart failure?
Combination diuretic therapy in acute heart failure improves early decongestion without affecting overall prognosis, though the specific addition of SGLT2 inhibitors during hospitalization significantly reduces heart failure events and worsening renal function.
AIMS: Current guideline recommendation to use escalating doses of loop diuretics in acute heart failure (AHF) is limited by worsening renal function and by diuretic resistance. There is an unmet need for novel therapeutic strategies to treat these patients. The aim of this study was to evaluate efficacy and safety of different combination diuretic strategies in patients with AHF. METHODS AND RESULTS: A systematic search identified 11 eligible randomized controlled trials involving 7517 patients. A combination diuretic strategy was not associated with reduction of all-cause death (relative risk RR 0.97, 95% confidence interval CI 0.89-1.07, p = 0.55) or heart failure (HF) events (RR 0.83, 95% CI 0.64-1.08, p = 0.16), but was associated with more weight loss (mean difference MD: -0.96, 95% CI -1.37 to -0.54, p 0.3 mg/dl of serum creatinine and/or a reduction >50% of the estimated glomerular filtration rate compared with baseline levels) (RR 0.69, 95% CI 0.50-0.96, p = 0.03). CONCLUSIONS: In patients with AHF, a combination diuretic strategy improved early decongestion without affecting prognosis. The use of SGLT2i during index hospitalization was associated with an improvement in all-cause mortality and HF events.
Fioretti et al. (Mon,) studied this question.