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Decongestion (instead of ultrafiltration?).
Schuermans, Art; Verbrugge, Frederik H.
Afiliación
  • Schuermans A; Faculty of Medicine, KU Leuven, Leuven.
  • Verbrugge FH; Centre for Cardiovascular Diseases, University Hospital Brussels.
Curr Opin Cardiol ; 39(3): 188-195, 2024 05 01.
Article en En | MEDLINE | ID: mdl-38362936
ABSTRACT
PURPOSE OF REVIEW To summarize the contemporary evidence on decongestion strategies in patients with acute heart failure (AHF). RECENT

FINDINGS:

While loop diuretic therapy has remained the backbone of decongestive treatment in AHF, multiple randomized clinical trials suggest that early combination with other diuretic classes or molecules with diuretic properties should be considered. Mineralocorticoid receptor antagonists and sodium-glucose co-transporter-2 inhibitors are disease-modifying drugs in heart failure that favourably influence prognosis early on, advocating their start as soon as possible in the absence of any compelling contraindications. Short-term upfront use of acetazolamide in adjunction to intravenous loop diuretic therapy relieves congestion faster, avoids diuretic resistance, and may shorten hospitalization length. Thiazide-like diuretics remain a good option to break diuretic resistance. Currently, ultrafiltration in AHF remains mainly reserved for patient with an inadequate response to pharmacological treatment.

SUMMARY:

In most patients with AHF, decongestion can be achieved effectively and safely through combination diuretic therapies. Appropriate diuretic therapy may shorten hospitalization length and improve quality of life, but has not yet proven to reduce death or heart failure readmissions. Ultrafiltration currently has a limited role in AHF, mainly as bail-out strategy, but evidence for a more upfront use remains inconclusive.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico / Insuficiencia Cardíaca Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Humans Idioma: En Revista: Curr Opin Cardiol / Curr. opin. cardiol / Current opinion in cardiology Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico / Insuficiencia Cardíaca Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Humans Idioma: En Revista: Curr Opin Cardiol / Curr. opin. cardiol / Current opinion in cardiology Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article