Diuretic Treatment in Heart Failure

To the Editor: The review article by Ellison and Felker (Nov.16 issue) 1 has a two-edged potential.Physicians are encouraged to use diuretics as first-line therapy for heart failure, but discontent with the drugs runs like a thread through the review.We had hoped that the section on other approaches and future directions would address how to minimize the use of diuretics.Long-term use of diuretic therapy for chronic heart failure may contribute to neurohumoral stimulation. 2Therefore, not only does skillful use of diuretic therapy remain fundamental to the successful management of heart failure, but so do strategies for their avoidance.First-line use of diuretics might influence adequate dosing of cardioprotective drugs, and the promotion of cardiac regeneration may become impractical.The latter is of particular importance the younger the patient with heart failure. 3