Key result
Decongestion is the primary treatment goal in acute and worsening heart failure, and achieving euvolemia is crucial despite transient worsening renal function, as residual congestion strongly predicts worse outcomes.
Why the study?
In acute heart failure, decongestion is the primary goal, but diuretic therapy is challenged by diuretic resistance and poor response across the heart failure spectrum.
This review emphasizes the critical importance of overcoming diuretic resistance to achieve complete decongestion in acute heart failure patients.
Diuretic resistance limits AHF decongestion; leaves open optimal strategies for poor responders in trials.
Hospitalisation for acute heart failure (AHF) is associated with high mortality and high rehospitalisation rates. In the absence of evidence-based therapy, treatment is aimed at stabilisation and symptom relief. The majority of AHF patients have signs and symptoms of fluid overload, and, therefore, decongestion is the number one treatment goal. Diuretics are the cornerstone of therapy in AHF, but the treatment effect is challenged by diuretic resistance and poor diuretic response throughout the spectrum of chronic to worsening to acute to post-worsening HF. Adequate dosing and monitoring and evaluation of diuretic effect are important for treatment success. Residual congestion at discharge is a strong predictor of worse outcomes. Therefore, achieving euvolaemia is crucial despite transient worsening renal function.
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Kristjánsdóttir et al. (2020) conducted a review in Acute or Worsening Heart Failure. Diuretics and decongestive therapies was evaluated. Decongestion is the primary treatment goal in acute and worsening heart failure, and achieving euvolemia is crucial despite transient worsening renal function, as residual congestion strongly predicts worse outcomes.
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