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Review
. 2019 Sep 30;20(3):111-120.
doi: 10.31083/j.rcm.2019.03.562.

Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review

Girish Singhania  1 , Abutaleb A Ejaz  2 , Peter A McCullough  3   4   5   6 , Aaron Y Kluger  3   7 , Saravanan Balamuthusamy  8   9 , Bhagwan Dass  10 , Namrata Singhania  11 , Adhish Agarwal  12
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Free article
Review

Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review

Girish Singhania et al. Rev Cardiovasc Med. .
Free article

Abstract

Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function.

Keywords: Acute heart failure; cardiorenal syndrome; cardiovascular outcomes; medication continuation; medication discontinuation.

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Conflict of interest statement

All the authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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