Title:Loop Diuretics Strategies in Acute Heart Failure: From Clinical Trials to Practical Application
Volume: 16
Issue: 11
Author(s): Alberto Palazzuoli, Gaetano Ruocco, Marco Pellegrini, Matteo Beltrami, Gabriele Del Castillo and Ranuccio Nuti
Affiliation:
Keywords:
Acute heart failure, hospitalization, loop diuretic, outcome, treatment, worsening renal function.
Abstract: Although loop diuretics are the most commonly used drugs for the treatment of acute heart
failure (AHF), their short and long-term effects are relatively unknown. The use of loop diuretics is essential
in the management of HF, particularly during episodes of acute decompensation, therefore
more than 90% of patients admitted with HF receive this drug. The administration of intravenous loop
diuretics to patients with heart failure and congestion typically results in the improvement of dyspnea,
pulmonary congestion and in the reduction of Left Ventricular (LV) filling pressures. However, little is
known about its appropriate dose, timing and modality administration in patients with AHF: several
side effects may result from the administration of high diuretics dose, including worsening kidney
function, diuretic resistance and sympathetic overdrive. Furthermore, there is no specific strategy that shows a clear benefit
in HF outcome in relation to continuous versus intermittent administration modalities. Current data based on small and
heterogeneous studies did not demonstrate a clear risk benefit ratio and larger prospective trials need to be completed in
order to be able to provide definitive recommendations in the future. Since every patient represents a single entity and
may have different responses to the same treatment, the best clinical approach should take into account physical examination,
neuro-hormonal overdrive and kidney functional status. Due to these reasons, treatment with loop diuretics should be
specifically customized for each patient, until multicenter blinded trials will provide satisfactory answers regarding optimal
dosing, modality administration and precise targets.
