Emerging Role of Low-dose Loop Diuretics in the Management of Heart Failure Patients to Maintain Euvolemia

Abstract

The current scenario of employing loop diuretics in combination with guideline-directed medical therapy (GDMT) demonstrates a comprehensive approach to improving clinical outcomes in individuals with heart failure (HF). GDMT uses four types of drugs: angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Torsemide, furosemide, and bumetanide are common loop diuretics used to control fluid overload in HF and provide symptomatic relief. Furthermore, loop diuretics are frequently used in advanced and decompensated HF. The combination of GDMT and loop diuretics is designed to improve quality of life, reduce hospitalization rates, and increase survival. Guidelines suggest the use of low-dose loop diuretics in patients with HF who have a previous history of congestion to maintain euvolemia. According to recent studies and guidelines, individualized regimens for the use of GDMT and loop diuretics are required to optimize therapeutic efficacy in terms of clinical status, fluid retention, electrolyte balance, and renal function.