Exploring the Role of Hypertonic Saline in Ambulatory Heart Failure Management: One Size Does Not Fit All?

This article refers to ‘Efficacy and safety of hypertonic saline therapy in ambulatory patients with heart failure: The SALT-HF trial’ by M. Cobo Marcos et al. , published in Eur J Heart Fail 2024;26:2 11 8–2 1 28. Hypertonic saline solution (HSS) has garnered attention as a potential adjunct therapy to enhance diuretic response in heart failure (HF). The underlying concept leverages the osmotic properties of HSS to draw fluid from the interstitial and intracellular spaces into the intravascular compartment, thereby boosting diuresis. Initial promising results came from an Italian team led by Paterna et al. , 1 ,2 who demonstrated significant clinical improvements in patients with acute decompensated HF, refractory to classical approaches, when high-dose furosemide was combined with small-volume HSS.