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Decongestion in acute heart failure.

Publication ,  Journal Article
Mentz, RJ; Kjeldsen, K; Rossi, GP; Voors, AA; Cleland, JGF; Anker, SD; Gheorghiade, M; Fiuzat, M; Rossignol, P; Zannad, F; Pitt, B; Felker, GM ...
Published in: Eur J Heart Fail
May 2014

Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants and serelaxin. Uncertainty exists with respect to the appropriate decongestion strategy for an individual patient. In this review, we summarize the benefit and risk profiles for these decongestion strategies and provide guidance on selecting an appropriate approach for different patients. An evidence-based initial approach to congestion management involves high-dose i.v. diuretics with addition of vasodilators for dyspnoea relief if blood pressure allows. To enhance diuresis or overcome diuretic resistance, options include dual nephron blockade with thiazide diuretics or natriuretic doses of mineralocorticoid receptor antagonists. Vasopressin antagonists may improve aquaresis and relieve dyspnoea. If diuretic strategies are unsuccessful, then ultrafiltration may be considered. Ultrafiltration should be used with caution in the setting of worsening renal function. This review is based on discussions among scientists, clinical trialists, and regulatory representatives at the 9th Global Cardio Vascular Clinical Trialists Forum in Paris, France, from 30 November to 1 December 2012.

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Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

May 2014

Volume

16

Issue

5

Start / End Page

471 / 482

Location

England

Related Subject Headings

  • Risk Assessment
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome Assessment, Health Care
  • Humans
  • Heart Failure
  • Evidence-Based Practice
  • Dyspnea
  • Disease Management
  • Cardiovascular System & Hematology
 

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Mentz, R. J., Kjeldsen, K., Rossi, G. P., Voors, A. A., Cleland, J. G. F., Anker, S. D., … Felker, G. M. (2014). Decongestion in acute heart failure. Eur J Heart Fail, 16(5), 471–482. https://doi.org/10.1002/ejhf.74
Mentz, Robert J., Keld Kjeldsen, Gian Paolo Rossi, Adriaan A. Voors, John G. F. Cleland, Stefan D. Anker, Mihai Gheorghiade, et al. “Decongestion in acute heart failure.Eur J Heart Fail 16, no. 5 (May 2014): 471–82. https://doi.org/10.1002/ejhf.74.
Mentz RJ, Kjeldsen K, Rossi GP, Voors AA, Cleland JGF, Anker SD, et al. Decongestion in acute heart failure. Eur J Heart Fail. 2014 May;16(5):471–82.
Mentz, Robert J., et al. “Decongestion in acute heart failure.Eur J Heart Fail, vol. 16, no. 5, May 2014, pp. 471–82. Pubmed, doi:10.1002/ejhf.74.
Mentz RJ, Kjeldsen K, Rossi GP, Voors AA, Cleland JGF, Anker SD, Gheorghiade M, Fiuzat M, Rossignol P, Zannad F, Pitt B, O’Connor C, Felker GM. Decongestion in acute heart failure. Eur J Heart Fail. 2014 May;16(5):471–482.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

May 2014

Volume

16

Issue

5

Start / End Page

471 / 482

Location

England

Related Subject Headings

  • Risk Assessment
  • Practice Guidelines as Topic
  • Patient Selection
  • Outcome Assessment, Health Care
  • Humans
  • Heart Failure
  • Evidence-Based Practice
  • Dyspnea
  • Disease Management
  • Cardiovascular System & Hematology