Login Register Cart 0
Generic placeholder image

Current Pharmaceutical Design

Editor-in-Chief

ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Overview of the Treatment of Congestion in Heart Failure

Author(s): Julia Martinez-Sole, Jose Carlos Sanchez-Martinez, Raquel Lopez-Vilella, Victor Donoso-Trenado, Ignacio Sanchez-Lazaro, Luis Almenar-Bonet, Jorge Sanz-Sanchez* and Luis Martinez-Dolz*

Volume 29, Issue 20, 2023

Published on: 20 July, 2023

Page: [1592 - 1601] Pages: 10

DOI: 10.2174/1381612829666230714153404

Price: $65

Abstract

Heart failure is a major problem in developed countries, leading to a high number of hospitalizations and healthcare costs. The most common symptom of heart failure is congestion, which is also the primary reason for hospitalization. Diuretics, particularly loop diuretics, are the cornerstone of the treatment of congestion. Likewise, there are other types of diuretics with different pathways of action, bioavailability profiles, adverse reactions, and effects on the cardiovascular and renal systems. Moreover, in recent years, new therapeutic alternatives have been proposed for challenging cases of diuretic resistance, such as ultrafiltration through peripheral access or peritoneal dialysis. The main objective of this article is to provide a step-guided approach to the management of congestion in patients with heart failure in order to guide the medical practice. Despite the significant amount of research published in recent years, there are no clear algorithms for managing acute heart failure. Diuretics remain the primary treatment of acute heart failure, and nephron blockade is key, but new therapies are emerging, and ongoing research is needed to develop better strategies for managing this condition.

Keywords: Acute heart failure, congestion, diuretics, diuretic refractoriness, nephron blockade, heart failure, loop diuretics, thiazide diuretics, sodium-glucose cotransporter 2 inhibitor, peritoneal dialysis, ultrafiltration.

« Previous Next »
[1]
Libby P, Bonow RO, Mann DL, et al. Braunwald’s Heart Disease-E-Book: A Textbook of Cardiovascular Medicine. Amsterdam: Elsevier 2021.
[2]
Martens P, Nijst P, Mullens W. Current approach to decongestive therapy in acute heart failure. Curr Heart Fail Rep 2015; 12(6): 367-78.
[http://dx.doi.org/10.1007/s11897-015-0273-5] [PMID: 26486631]
[3]
Boorsma EM, ter Maaten JM, Damman K, et al. Congestion in heart failure: A contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol 2020; 17(10): 641-55.
[http://dx.doi.org/10.1038/s41569-020-0379-7] [PMID: 32415147]
[4]
Rubio-Gracia J, Demissei BG, ter Maaten JM, et al. Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. Int J Cardiol 2018; 258: 185-91.
[http://dx.doi.org/10.1016/j.ijcard.2018.01.067] [PMID: 29544928]
[5]
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79(17): e263-421.
[http://dx.doi.org/10.1016/j.jacc.2021.12.012] [PMID: 35379503]
[6]
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42(36): 3599-726.
[http://dx.doi.org/10.1093/eurheartj/ehab368] [PMID: 34447992]
[7]
Koeppen BM, Stanton BA. Renal Physiology: Mosby Physiology Monograph Series. Missouri: Mosby 2021.
[8]
Ellison DH. The physiologic basis of diuretic synergism: Its role in treating diuretic resistance. Ann Intern Med 1991; 114(10): 886-94.
[http://dx.doi.org/10.7326/0003-4819-114-10-886] [PMID: 2014951]
[9]
Jentzer JC, DeWald TA, Hernandez AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol 2010; 56(19): 1527-34.
[http://dx.doi.org/10.1016/j.jacc.2010.06.034] [PMID: 21029871]
[10]
López-Vilella R, Jover-Pastor P, Donoso-Trenado V. Clinical phenotypes according to diuretic combination in acute heart failure. Hellenic J Cardiol S1109-9666(23): 00056-8.
[11]
Murray MD, Deer MM, Ferguson JA, et al. Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure. Am J Med 2001; 111(7): 513-20.
[http://dx.doi.org/10.1016/S0002-9343(01)00903-2] [PMID: 11705426]
[12]
Vargo DL, Kramer WG, Black PK, Smith WB, Serpas T, Brater DC. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther 1995; 57(6): 601-9.
[http://dx.doi.org/10.1016/0009-9236(95)90222-8] [PMID: 7781259]
[13]
Cosín J, Díez J. Torasemide in chronic heart failure: Results of the TORIC study. Eur J Heart Fail 2002; 4(4): 507-13.
[http://dx.doi.org/10.1016/S1388-9842(02)00122-8] [PMID: 12167392]
[14]
Faris R, Flather M, Purcell H, Henein M, Poole-Wilson P, Coats A. Current evidence supporting the role of diuretics in heart failure: A meta analysis of randomised controlled trials. Int J Cardiol 2002; 82(2): 149-58.
[http://dx.doi.org/10.1016/S0167-5273(01)00600-3] [PMID: 11853901]
[15]
Faselis C, Arundel C, Patel S, et al. Loop diuretic prescription and 30- day outcomes in older patients with heart failure. J Am Coll Cardiol 2020; 76(6): 669-79.
[http://dx.doi.org/10.1016/j.jacc.2020.06.022] [PMID: 32762901]
[16]
Hall JE. Guyton and Hall textbook of medical physiology. Philadelphia: Saunders 2011.
[17]
Felker GM, Lee KL, Bull DA, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011; 364(9): 797-805.
[http://dx.doi.org/10.1056/NEJMoa1005419] [PMID: 21366472]
[18]
López-Vilella R, Sánchez-Lázaro I, Husillos Tamarit I, et al. Administration of subcutaneous furosemide in elastomeric pump vs. oral solution for the treatment of diuretic refractory congestion. High Blood Press Cardiovasc Prev 2021; 28(6): 589-96.
[http://dx.doi.org/10.1007/s40292-021-00476-4] [PMID: 34596886]
[19]
Trullàs JC, Morales-Rull JL, Casado J, et al. Combining loop with thiazide diuretics for decompensated heart failure: The CLOROTIC trial. Eur Heart J 2023; 44(5): 411-21.
[http://dx.doi.org/10.1093/eurheartj/ehac689] [PMID: 36423214]
[20]
Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341(10): 709-17.
[http://dx.doi.org/10.1056/NEJM199909023411001] [PMID: 10471456]
[21]
Zannad F, McMurray JJV, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364(1): 11-21.
[http://dx.doi.org/10.1056/NEJMoa1009492] [PMID: 21073363]
[22]
Wongboonsin J, Thongprayoon C, Bathini T, et al. Acetazolamide therapy in patients with heart failure: A meta-analysis. J Clin Med 2019; 8(3): 349.
[http://dx.doi.org/10.3390/jcm8030349] [PMID: 30871038]
[23]
Mullens W, Dauw J, Martens P, et al. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med 2022; 387(13): 1185-95.
[http://dx.doi.org/10.1056/NEJMoa2203094] [PMID: 36027559]
[24]
Konstam MA, Gheorghiade M, Burnett JC Jr, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: The EVEREST Outcome Trial. JAMA 2007; 297(12): 1319-31.
[http://dx.doi.org/10.1001/jama.297.12.1319] [PMID: 17384437]
[25]
Felker GM, Mentz RJ, Cole RT, et al. Efficacy and safety of tolvaptan in patients hospitalized with acute heart failure. J Am Coll Cardiol 2017; 69(11): 1399-406.
[http://dx.doi.org/10.1016/j.jacc.2016.09.004] [PMID: 27654854]
[26]
Packer M, Anker SD, Butler J, et al. Effect of empagliflozin on the clinical stability of patients with heart failure and a reduced ejection fraction: The EMPEROR-Reduced trial. Circulation 2021; 143(4): 326-36.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.120.051783] [PMID: 33081531]
[27]
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381(21): 1995-2008.
[http://dx.doi.org/10.1056/NEJMoa1911303] [PMID: 31535829]
[28]
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021; 385(16): 1451-61.
[http://dx.doi.org/10.1056/NEJMoa2107038] [PMID: 34449189]
[29]
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2022; 387(12): 1089-98.
[http://dx.doi.org/10.1056/NEJMoa2206286] [PMID: 36027570]
[30]
Paterna S, Fasullo S, Cannizzaro S, et al. Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (Class C) (SMAC-HF Study). Am J Med Sci 2011; 342(1): 27-37.
[http://dx.doi.org/10.1097/MAJ.0b013e31820f10ad] [PMID: 21701268]
[31]
Liu C, Peng Z, Gao X, et al. Simultaneous use of hypertonic saline and IV furosemide for fluid overload: A systematic review and meta-analysis. Crit Care Med 2021; 49(11): e1163-75.
[http://dx.doi.org/10.1097/CCM.0000000000005174] [PMID: 34166286]
[32]
Setoguchi S, Stevenson LW, Schneeweiss S. Repeated hospitalizations predict mortality in the community population with heart failure. Am Heart J 2007; 154(2): 260-6.
[http://dx.doi.org/10.1016/j.ahj.2007.01.041] [PMID: 17643574]
[33]
Lee DS, Austin PC, Stukel TA, et al. “Dose-dependent” impact of recurrent cardiac events on mortality in patients with heart failure. Am J Med 2009; 122(2): 162.e1-9.
[http://dx.doi.org/10.1016/j.amjmed.2008.08.026] [PMID: 19100960]
[34]
Costanzo MR, Negoianu D, Jaski BE, et al. Aquapheresis versus intravenous diuretics and hospitalizations for heart failure. JACC Heart Fail 2016; 4(2): 95-105.
[http://dx.doi.org/10.1016/j.jchf.2015.08.005] [PMID: 26519995]
[35]
López-Vilella R, Sánchez-Lázaro I, Cervera BG, Trenado VD, Orient AS, Bonet LA. Ultrafiltración de acceso periférico como tratamiento del síndrome cardiorrenal con insuficiente respuesta diurética. Rev Espanola Cardiol Engl 2022; 76(1): 60-2.
[36]
Costanzo MR, Ronco C, Abraham WT, et al. Extracorporeal ultrafiltration for fluid overload in heart failure. J Am Coll Cardiol 2017; 69(19): 2428-45.
[http://dx.doi.org/10.1016/j.jacc.2017.03.528] [PMID: 28494980]
[37]
Felker GM, Mentz RJ. Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol 2012; 59(24): 2145-53.
[http://dx.doi.org/10.1016/j.jacc.2011.10.910] [PMID: 22676934]
[38]
Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007; 49(6): 675-83.
[http://dx.doi.org/10.1016/j.jacc.2006.07.073] [PMID: 17291932]
[39]
Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 2012; 367(24): 2296-304.
[http://dx.doi.org/10.1056/NEJMoa1210357] [PMID: 23131078]
[40]
Marenzi G, Muratori M, Cosentino ER, et al. Continuous ultrafiltration for congestive heart failure: The CUORE trial. J Card Fail 2014; 20(1): 9-17.
[http://dx.doi.org/10.1016/j.cardfail.2013.11.004] [PMID: 24269855]
[41]
François K, Ronco C, Bargman JM. Peritoneal dialysis for chronic congestive heart failure. Blood Purif 2015; 40(1): 45-52.
[http://dx.doi.org/10.1159/000430084] [PMID: 26111872]
[42]
Bertoli SV, Musetti C, Ciurlino D, et al. Peritoneal ultrafiltration in refractory heart failure: A cohort study. Perit Dial Int 2014; 34(1): 64-70.
[http://dx.doi.org/10.3747/pdi.2012.00290] [PMID: 24179103]
[43]
Courivaud C, Kazory A, Crépin T, et al. Peritoneal dialysis reduces the number of hospitalization days in heart failure patients refractory to diuretics. Perit Dial Int 2014; 34(1): 100-8.
[http://dx.doi.org/10.3747/pdi.2012.00149] [PMID: 23994842]
[44]
Cnossen TT, Kooman JP, Konings CJAM, Uszko-Lencer NHMK, Leunissen KML, van der Sande FM. Peritoneal dialysis in patients with primary cardiac failure complicated by renal failure. Blood Purif 2010; 30(2): 146-52.
[http://dx.doi.org/10.1159/000321102] [PMID: 20847552]
[45]
Kunin M, Arad M, Dinour D, Freimark D, Holtzman EJ. Peritoneal dialysis in patients with refractory congestive heart failure: Potential prognostic factors. Blood Purif 2013; 35(4): 285-94.
[http://dx.doi.org/10.1159/000351202] [PMID: 23712042]
[46]
Cnossen TT, Kooman JP, Krepel HP, Konings CJAM, Uszko- Lencer NHMK, Leunissen KML, et al. Prospective study on clinical effects of renal replacement therapy in treatment-resistant congestive heart failure. Nephrol Dial Transplant 2012; 27(7): 2794-9.
[http://dx.doi.org/10.1093/ndt/gfr756]
[47]
Koch M, Haastert B, Kohnle M, et al. Peritoneal dialysis relieves clinical symptoms and is well tolerated in patients with refractory heart failure and chronic kidney disease. Eur J Heart Fail 2012; 14(5): 530-9.
[http://dx.doi.org/10.1093/eurjhf/hfs035] [PMID: 22447950]
[48]
Rizkallah J, Sood MM, Reslerova M, et al. Reduced hospitalizations in severe, refractory congestive heart failure with peritoneal dialysis: A consecutive case series. Clin Nephrol 2013; 80(11): 334-41.
[http://dx.doi.org/10.5414/CN108038] [PMID: 23993167]
[49]
Sánchez JE, Ortega T, Rodríguez C, Díaz-Molina B, Martín M, Garcia-Cueto C, et al. Efficacy of peritoneal ultrafiltration in the treatment of refractory congestive heart failure. Nephrol Dial Transplant 2010; 25(2): 605-10.
[http://dx.doi.org/10.1093/ndt/gfp484]
[50]
Núñez J, González M, Miñana G, et al. Continuous ambulatory peritoneal dialysis as a therapeutic alternative in patients with advanced congestive heart failure. Eur J Heart Fail 2012; 14(5): 540-8.
[http://dx.doi.org/10.1093/eurjhf/hfs013] [PMID: 22327061]
[51]
Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: The Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol 2005; 46(11): 2043-6.
[http://dx.doi.org/10.1016/j.jacc.2005.05.098] [PMID: 16325039]
[52]
Marjani N, Dareini M, Asadzade-Lotfabad M, et al. Evaluation of the binding effect and cytotoxicity assay of 2-Ethyl-5-(4-methylphenyl) pyramido pyrazole ophthalazine trione on calf thymus DNA: Spectroscopic, calorimetric, and molecular dynamics approaches. Luminescence 2022; 37(2): 310-22.
[http://dx.doi.org/10.1002/bio.4173] [PMID: 34862709]
[53]
Khashkhashi-Moghadam S, Ezazi-Toroghi S, Kamkar-Vatanparast M, et al. Novel perspective into the interaction behavior study of the cyanidin with human serum albumin-holo transferrin complex: Spectroscopic, calorimetric and molecular modeling approaches. J Mol Liq 2022; 356: 119042.
[http://dx.doi.org/10.1016/j.molliq.2022.119042]
[54]
Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019; 380(4): 347-57.
[http://dx.doi.org/10.1056/NEJMoa1812389] [PMID: 30415602]
[55]
Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373(22): 2117-28.
[http://dx.doi.org/10.1056/NEJMoa1504720] [PMID: 26378978]

Rights & Permissions Print Cite
Article Metrics
47
2
© 2024 Bentham Science Publishers | Privacy Policy