Overview of the Treatment of Congestion in Heart Failure

Autores de IIS La Fe

• Julia Martínez Solé

  Autor

• Jose Carlos Sanchez Martinez

  Autor

• Raquel López Vilella

  Autor

• Víctor José Donoso Trenado

  Autor

• Ignacio José Sánchez Lázaro

  Autor

• Luis Almenar Bonet

  Autor

• Jorge Sanz Sánchez

  Autor

• 

  Luis Vicente Martínez Dolz

  Autor

Grupos

• Cardiopatías familiares, muerte súbita y mecanismos de enfermedad (CAFAMUSME)

• Grupo de Investigación Clínica y Traslacional en Cardiología

Abstract

Heart failure is a major problem in developed countries, leading to a high number of hospitalizations and healthcare costs. The most common symptom of heart failure is congestion, which is also the primary reason for hospitalization. Diuretics, particularly loop diuretics, are the cornerstone of the treatment of congestion. Likewise, there are other types of diuretics with different pathways of action, bioavailability profiles, adverse reactions, and effects on the cardiovascular and renal systems. Moreover, in recent years, new therapeutic alternatives have been proposed for challenging cases of diuretic resistance, such as ultrafiltration through peripheral access or peritoneal dialysis. The main objective of this article is to provide a step-guided approach to the management of congestion in patients with heart failure in order to guide the medical practice. Despite the significant amount of research published in recent years, there are no clear algorithms for managing acute heart failure. Diuretics remain the primary treatment of acute heart failure, and nephron blockade is key, but new therapies are emerging, and ongoing research is needed to develop better strategies for managing this condition.

Keywords

• Acute heart failure; congestion; diuretics; diuretic refractoriness; nephron blockade; heart failure; loop diuretics; thiazide diuretics; sodium-glucose cotransporter 2 inhibitor; peritoneal dialysis; ultrafiltration