Optimal Diuretic Strategies for Chronic Heart Failure

Loop diuretics are Class I recommended for managing congestion in chronic heart failure, though their effect on morbidity and mortality remains uncertain due to limited large-scale evidence. Current guidelines recommend using the lowest effective dose to maintain euvolemia while minimizing adverse effects through individualized care. Personalized monitoring-including clinical evaluation, biomarkers, and hemodynamic parameters-is essential to guide therapy. Optimizing guideline-directed medical therapy (GDMT), particularly angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, and mineralocorticoid receptor antagonists, may support diuretic minimization. Integrating GDMT with tailored monitoring may improve loop diuretic use and improve clinical outcomes in chronic heart failure management.