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Review
. 2024 Oct;26(10):2094-2106.
doi: 10.1002/ejhf.3423. Epub 2024 Aug 21.

Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?

Jan Biegus  1 , Gad Cotter  2   3 , Marco Metra  4 , Piotr Ponikowski  1
Affiliations
Review

Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?

Jan Biegus et al. Eur J Heart Fail. 2024 Oct.

Abstract

Congestion is a common cause of clinical deterioration and the most common clinical presentation at admission in acute heart failure (HF). Therefore, finding effective and sustainable ways to alleviate congestion has become a crucial goal for treating HF patients. Congestion is a result of complex underlying pathophysiology; therefore, it is not a direct cause of the disease but its consequence. Any therapy that directly promotes sodium/water removal only, thus targeting only clinical symptoms, neither modifies the natural course of the disease nor improves prognosis. This review aims to provide a comprehensive evaluation of the current decongestive therapies and propose a new (not diuretic-centred) paradigm of long-term congestion management in HF that attempts to correct the underlying pathophysiology, thus improving congestion, preventing its development, and favourably altering the natural course of the disease rather than merely treating its symptoms.

Keywords: Congestion; Decongestion; Diuretics; Guideline‐directed medical therapy.

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References

    1. Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo‐Leiro MG, et al.; ESC Heart Failure Long‐Term Registry Investigators. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: The ESC Heart Failure Long‐Term Registry. Eur J Heart Fail 2017;19:1242–1254. https://doi.org/10.1002/ejhf.890
    1. Filippatos G, Angermann CE, Cleland JGF, Lam CSP, Dahlström U, Dickstein K, et al. Global differences in characteristics, precipitants, and initial management of patients presenting with acute heart failure. JAMA Cardiol 2020;5:401–410. https://doi.org/10.1001/jamacardio.2019.5108
    1. Metra M, Tomasoni D, Adamo M, Bayes‐Genis A, Filippatos G, Abdelhamid M, et al. Worsening of chronic heart failure: Definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023;25:776–791. https://doi.org/10.1002/ejhf.2874
    1. Mentz RJ, Kjeldsen K, Rossi GP, Voors AA, Cleland JGF, Anker SD, et al. Decongestion in acute heart failure. Eur J Heart Fail 2014;16:471–482. https://doi.org/10.1002/ejhf.74
    1. Ambrosy AP, Cerbin LP, Armstrong PW, Butler J, Coles A, DeVore AD, et al. Body weight change during and after hospitalization for acute heart failure: Patient characteristics, markers of congestion, and outcomes: Findings from the ASCEND‐HF trial. JACC Heart Fail 2017;5:1–13. https://doi.org/10.1016/j.jchf.2016.09.012