title: Combination decongestion therapy in hospitalized heart failure: loop diuretics, mineralocorticoid receptor antagonists and vasopressin antagonists.
abstract: Congestion is the most common reason for admissions and readmissions for heart failure (HF). The vast majority of hospitalized HF patients appear to respond readily to loop diuretics, but available data suggest that a significant proportion are being discharged with persistent evidence of congestion. Although novel therapies targeting congestion should continue to be developed, currently available agents may be utilized more optimally to facilitate complete decongestion. The combination of loop diuretics, natriuretic doses of mineralocorticoid receptor antagonists and vasopressin antagonists represents a regimen of currently available therapies that affects early and persistent decongestion, while limiting the associated risks of electrolyte disturbances, hemodynamic fluctuations, renal dysfunction and mortality.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists
keywords: heart failure; loop diuretics; mineralocorticoid receptor antagonists; neurohormones; vasopressin antagonists