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[Diuretic treatment in patients with chronic heart failure: evidences, experiences, and current perspectives]
Pierpaolo Pellicori1, Valentina Carubelli2
1Academic Cardiology Unit, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK.
Insights
Diuretics are essential for managing chronic heart failure (CHF) congestion but lack proven mortality benefits. Further trials are needed to clarify optimal diuretic use and safety in CHF patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestion is a key clinical indicator in chronic heart failure (CHF).
- Diuretics are the primary treatment for managing fluid overload in CHF.
- Current evidence does not support diuretic use for improving mortality in CHF patients.
Purpose of the Study:
- To review existing evidence on the clinical application of diuretics in CHF.
- To identify gaps in knowledge regarding diuretic management in CHF.
- To emphasize the necessity for further research into diuretic therapy for CHF.
Main Methods:
- Literature review of current evidence on diuretic use in CHF.
- Analysis of clinical trials and studies concerning diuretic efficacy and safety.
- Discussion of titration strategies and discontinuation of diuretics in CHF.
Main Results:
- No randomized trials have demonstrated a mortality benefit of diuretics in CHF.
- Uncertainty exists regarding optimal diuretic titration and discontinuation protocols.
- Evidence on the comparative efficacy and safety of different diuretic classes in CHF is limited.
Conclusions:
- The role of diuretics in improving long-term outcomes for CHF patients requires further investigation.
- More clinical trials are essential to determine the safety, efficacy, and benefits of various diuretics in CHF.
- Optimizing diuretic therapy is crucial for managing congestion and improving patient care in CHF.
Abstract:
Congestion is a fundamental clinical sign in patients with chronic heart failure (CHF). Diuretics are the mainstay treatment for congestion but, so far, no randomized trial has ever shown any beneficial effect of diuretics on mortality in patients with CHF. It is also unclear how and when diuretics should be up, or down titrated, or when their use can be safely stopped. In this review, we discuss current evidence regarding the clinical use of diuretics. We also highlight the need for more clinical trials to explore the short- and long-term safety, efficacy and clinical benefits of different classes of diuretics, used alone or in combination, in patients with CHF.