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Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions-Part II: Combination
Cuthbert J J1,2, Cleland J G F3, Clark A L4
1Centre for Clinical Sciences, Hull York Medical School, University of Hull, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, UK. Joe.cuthbert@hyms.ac.uk.
Insights
Loop diuretics remain a cornerstone for heart failure (HF) congestion, but evidence for optimal strategies is limited. Recent trials highlight the need for better diuretic research to improve patient outcomes.
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 are the main treatment for HF congestion but their use has seen little change in 50 years.
- Advances in disease-modifying therapies have not significantly altered diuretic treatment paradigms.
Purpose of the Study:
- To review the history of diuretic treatment in HF.
- To examine current trial evidence for various diuretic strategies.
- To explore future research directions in HF diuretic therapy.
Main Methods:
- Assessment of recent clinical trials including DOSE, TRANSFORM, ADVOR, CLOROTIC, OSPREY-AHF, and PUSH-AHF.
- Review of existing literature on diuretic use in heart failure.
- Analysis of how trial data may influence clinical practice and future research.
Main Results:
- Robust evidence supports high-dose loop diuretics over low-dose for hospitalized HF patients, yet this is not consistently reflected in guidelines.
- There is a significant lack of data to guide diuretic therapy decisions in clinical practice.
- Recent trials provide insights but highlight the urgent need for more comprehensive research.
Conclusions:
- Current diuretic strategies for heart failure congestion require further investigation and evidence-based refinement.
- High-dose loop diuretics show promise but require broader guideline integration and further study.
- Future research should focus on optimizing diuretic strategies to improve HF management and patient 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 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, 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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