Beyond diuretics: management of volume overload in acute heart failure syndromes.
Diuretics are an established foundation of therapy for patients with chronic heart failure (HF) as well as for those hospitalized for treatment of acute HF syndromes. Despite the accepted use of diuretics in acute HF syndromes, treatment patterns with diuretics vary widely, and there are no data from randomized studies on the benefit of diuretics on morbidity or mortality in patients hospitalized with acute HF syndromes. Additional pharmacologic therapies that complement or replace diuretics in this setting, especially in patients with diuretic resistance, include positive inotropes, nitrovasodilators, and natriuretic peptides, but data are likewise lacking on important clinical outcomes. Ultrafiltration has also been used as a nonpharmacologic strategy to treat patients with acute HF syndromes who exhibit resistance to diuretics. Effective monitoring of volume status with newer modalities may allow more selective use of diuretics and diuretic-like modalities, but additional randomized trial data are clearly needed to establish ideal strategies to promote volume removal in acute HF syndromes.
Hill
James A
JA
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA. hillja@medicine.ufl.edu
Yancy
Clyde W
CW
Abraham
William T
WT
D000208:Acute Disease; D001810:Blood Volume / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D013577:Syndrome; D014462:Ultrafiltration; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014882:Water-Electrolyte Balance / Q000187:drug effects*
D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents