Recent Insights into Dosing Diuretics for Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a major problem among the elderly requiring frequent hospitalizations. Although the vast majority of patients with ADHF require loop diuretic therapy to control symptoms, guidelines for their use have been driven primarily by small nonrandomized trials and observational studies. Ongoing debate has centered on the risks of adverse effects including renal dysfunction and the most appropriate method of administration to minimize these risks. Recently, a large prospective randomized trial, the Diuretic Optimization Strategies Evaluation (DOSE), addressed these issues. This article will review the findings of this trial and the implications for clinical practice.