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Comparative Study
. 2021 Apr;25(7):2971-2980.
doi: 10.26355/eurrev_202104_25550.

Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network meta-analysis

D Orso  1 , G Tavazzi, F Corradi, F Mearelli, N Federici, D Peric, N D'Andrea, G Santori, F Mojoli, F Forfori, L Vetrugno, T Bove
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Free article
Comparative Study

Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network meta-analysis

D Orso et al. Eur Rev Med Pharmacol Sci. 2021 Apr.
Free article

Abstract

Objective: Up to 50% of patients hospitalized for acute heart failure (AHF) show resistance to diuretics. This condition contributes to a prolonged hospital length of stay and a higher risk of death. This review aimed to investigate whether a diuretic therapeutic approach more effective than furosemide alone exists for patients with diuretic-resistant AHF.

Materials and methods: We identified all randomized controlled trials (RCTs) evaluating diuretic therapy in patients with diuretic-resistant AHF. We searched Pubmed, BioMed Central, and Cochrane CENTRAL databases.

Results: Six RCTs were identified, involving a total of 845 patients. The P-score ranges from 0.6663 for furosemide to 0.2294 for the tolvaptan-furosemide. We found no significant differences in efficacy for any drug comparison.

Conclusions: None of the diuretics considered in RCTs performed to date (tolvaptan, metolazone, hydrochlorothiazide, indapamide) appear to be more effective than furosemide therapy alone for the treatment of patients with diuretic-resistant AHF.

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