Congestion is a cardinal clinical feature of chronic heart failure linked to adverse outcomes, but despite diuretics being the mainstay of treatment, no randomized trials have shown their effects on mortality.
This review highlights the lack of randomized trial evidence for the mortality benefit of diuretics in chronic heart failure and calls for research into detecting and treating subclinical congestion.
Congestion, or fluid overload, is a classic clinical feature of patients presenting with heart failure patients, and its presence is associated with adverse outcome. However, congestion is not always clinically evident, and more objective measures of congestion than simple clinical examination may be helpful. Although diuretics are the mainstay of treatment for congestion, no randomised trials have shown the effects of diuretics on mortality in chronic heart failure patients. Furthermore, appropriate titration of diuretics in this population is unclear. Research is required to determine whether a robust method of detecting - and then treating - subclinical congestion improves outcomes.
Pellicori et al. (2015) conducted a review in Chronic Heart Failure. Fluid Management and Diuretics was evaluated. Congestion is a cardinal clinical feature of chronic heart failure linked to adverse outcomes, but despite diuretics being the mainstay of treatment, no randomized trials have shown their effects on mortality.