Discontinuation of loop diuretics in older patients with chronic stable heart failure – A narrative review

Loop diuretics (LD) represent the cornerstone treatment for relieving pulmonary congestion in patients with heart failure (HF). Their benefit is well-recognized in the short term because of their ability to eliminate fluid retention. However, long-term, they could adversely influence prognosis due to activation of the neurohumoral mechanism, particularly in older, frail patients. Moreover, the advent of new drugs capable of improving outcomes and reducing pulmonary and systemic congestion signs in HF emphasizes the possibility of a progressive reduction and discontinuation of loop diuretics treatment. Nevertheless, few studies aimed at investigating the safety of loop diuretics withdrawal in patients with chronic stable HF in older patients. The current review aims to approach current evidence regarding the safety and effectiveness of furosemide discontinuation in patients with chronic stable HF. This review is based on the material obtained via PubMed database and Scopus from January 2000 to November 2022. Our search yielded five relevant studies, including two RCTs. All the participants presented stable HF at the time of the study enrolment. Apart from one study, all the investigations were carried out in patients with HF with reduced Ejection Fraction. The most common outcomes examined were the need for diuretic resumption or the event of death and rehospitalization after diuretic withdrawal. As a whole, although based on a few investigations with a low grade of evidence, diuretic therapy discontinuation might be a safe strategy that deserves consideration for patients with stable HF. However, extensive investigations on older adults accounting for frailty status are warranted to confirm these data in this peculiar class of patients.