Diuretics for the treatment of acute decompensated heart failure

Diuretics have been a mainstay for the treatment of acute decompensated heart failure (ADHF) for the past four decades, though their short-term gains have been questioned recently given their potential long-term deleterious systemic effects. The methods of diuretic administration as well as the optimal dosing regimen of these agents are both areas that have been increasingly coming under scrutiny. The lack of rigorous clinical trials examining diuretic use in ADHF, however, has led to a general adoption of non-evidence based treatment algorithms for this patient population. Though the use of intravenous vasodilators for the treatment of decompensated heart failure has grown tremendously over the last few years, the fact remains that diuretics are still indispensable for alleviating congestive symptoms. Given this reality and until further information is available about the most ideal utilization of these medications, diuretics will continue to represent a double-edged sword for physicians treating this disease process.