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Review
. 2020 Sep 28:6:e25.
doi: 10.15420/cfr.2019.18. eCollection 2020 Mar.

Congestion and Diuretic Resistance in Acute or Worsening Heart Failure

Ingibjörg Kristjánsdóttir  1 , Tonje Thorvaldsen  1 , Lars H Lund  1
Affiliations
Review

Congestion and Diuretic Resistance in Acute or Worsening Heart Failure

Ingibjörg Kristjánsdóttir et al. Card Fail Rev. .

Abstract

Hospitalisation for acute heart failure (AHF) is associated with high mortality and high rehospitalisation rates. In the absence of evidence-based therapy, treatment is aimed at stabilisation and symptom relief. The majority of AHF patients have signs and symptoms of fluid overload, and, therefore, decongestion is the number one treatment goal. Diuretics are the cornerstone of therapy in AHF, but the treatment effect is challenged by diuretic resistance and poor diuretic response throughout the spectrum of chronic to worsening to acute to post-worsening HF. Adequate dosing and monitoring and evaluation of diuretic effect are important for treatment success. Residual congestion at discharge is a strong predictor of worse outcomes. Therefore, achieving euvolaemia is crucial despite transient worsening renal function.

Keywords: Diuretic resistance; acute heart failure; congestion; prognosis; worsening heart failure; worsening renal failure.

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Conflict of interest statement

Disclosure: TT has received speaker’s fees from Orionpharma, Bayer, and Novartis. LHL has received research grants to author’s institution, speaker’s and/or consulting fees from AstraZeneca, Novartis, Bayer, Vifor Pharma, Relypsa, Abbott, Sanofi, Merck, and Pharmacosmos. IK has no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Modifications to the Traditional View of the Course of Chronic Heart Failure
See this image and copyright information in PMC

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