This review outlines the pathophysiologic mechanisms of congestion in advanced heart failure and summarizes current and investigational therapeutic options for its management.
Does not alter current HF management; leaves open optimal integration of investigational congestion therapies.
Volume overload is a common manifestation of heart failure decompensation. Interaction between impaired renal and heart function constitutes an important pathophysiologic mechanism that leads to congestion. In addition to improving symptoms and volume status, reduction of rehospitalization rates, maintenance of renal function and improvement of survival are all important goals of every therapeutic strategy. Currently, the use of diuretics, vasodilators, inotropes and ultrafiltration, together with investigational agents such as oral vasopressin antagonists and adenosine A1-receptor antagonists, constitute the main therapeutic options for the congested heart failure patient.
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Bonios et al. (2011) studied this question.
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