Optimal Diuretic Strategies for Chronic Heart Failure.

Loop diuretics are Class I recommended for managing congestion in chronic heart failure, though their effect on morbidity and mortality remains uncertain due to limited large-scale evidence. Current guidelines recommend using the lowest effective dose to maintain euvolemia while minimizing adverse effects through individualized care. Personalized monitoring-including clinical evaluation, biomarkers, and hemodynamic parameters-is essential to guide therapy. Optimizing guideline-directed medical therapy (GDMT), particularly angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, and mineralocorticoid receptor antagonists, may support diuretic minimization. Integrating GDMT with tailored monitoring may improve loop diuretic use and improve clinical outcomes in chronic heart failure management.

Duke Scholars

Author Robert John Mentz Medicine, Cardiology