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Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions - Part I: Loop Diuretics
Joseph James Cuthbert1,2, Andrew L Clark3
1Clinical Sciences Centre, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, UK. Joe.cuthbert@hyms.ac.uk.
Insights
Loop diuretics remain the primary treatment for heart failure (HF) congestion, despite limited evidence. Recent trials highlight the need for better diuretic strategies and more research to improve patient outcomes in HF management.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Fluid retention is a primary cause of symptoms and poor quality of life in heart failure (HF) patients.
- Loop diuretics, the mainstay for managing HF congestion, have seen little change in treatment strategies for 50 years.
Purpose of the Study:
- To review the history and current evidence for diuretic treatment strategies in heart failure.
- To explore potential future research directions for optimizing diuretic therapy in HF.
Main Methods:
- Assessment of recent clinical trials, including DOSE, TRANSFORM, ADVOR, CLOROTIC, OSPREY-AHF, and PUSH-AHF.
- Evaluation of how trial evidence may influence current clinical practice and future research in HF management.
Main Results:
- Robust evidence supports high-dose loop diuretic treatment over low-dose for hospitalized HF patients, though this is not consistently reflected in guidelines.
- There is a significant lack of data to guide diuretic therapy decisions in routine clinical practice.
Conclusions:
- Current diuretic strategies for heart failure are not adequately supported by robust clinical evidence.
- There is an urgent need for more comprehensive research into various diuretic strategies to improve HF patient care and outcomes.
Purpose Of Review:
Fluid retention or congestion is a major cause of symptoms, poor quality of life, and adverse outcome in patients with heart failure (HF). Despite advances in disease-modifying therapy, the mainstay of treatment for congestion-loop diuretics-has remained largely unchanged for 50 years. In these two articles (part I: loop diuretics and part II: combination therapy), we will review the history of diuretic treatment and the current trial evidence for different diuretic strategies and explore potential future directions of research.
Recent Findings:
We will assess recent trials including DOSE, TRANSFORM, ADVOR, CLOROTIC, OSPREY-AHF, and PUSH-AHF amongst others, and assess how these may influence current practice and future research. There are few data on which to base diuretic therapy in clinical practice. The most robust evidence is for high dose loop diuretic treatment over low-dose treatment for patients admitted to hospital with HF, yet this is not reflected in guidelines. There is an urgent need for more and better research on different diuretic strategies in patients with HF.
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