Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?
Congestion
Decongestion
Diuretics
Guideline‐directed medical therapy
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
21 Aug 2024
21 Aug 2024
Historique:
revised:
18
07
2024
received:
10
06
2024
accepted:
25
07
2024
medline:
22
8
2024
pubmed:
22
8
2024
entrez:
22
8
2024
Statut:
aheadofprint
Résumé
Congestion is a common cause of clinical deterioration and the most common clinical presentation at admission in acute heart failure (HF). Therefore, finding effective and sustainable ways to alleviate congestion has become a crucial goal for treating HF patients. Congestion is a result of complex underlying pathophysiology; therefore, it is not a direct cause of the disease but its consequence. Any therapy that directly promotes sodium/water removal only, thus targeting only clinical symptoms, neither modifies the natural course of the disease nor improves prognosis. This review aims to provide a comprehensive evaluation of the current decongestive therapies and propose a new (not diuretic-centred) paradigm of long-term congestion management in HF that attempts to correct the underlying pathophysiology, thus improving congestion, preventing its development, and favourably altering the natural course of the disease rather than merely treating its symptoms.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Institute of Heart Diseases, Wroclaw Medical University, Poland
ID : SUBZ.A460.24.040
Informations de copyright
© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo‐Leiro MG, et al.; ESC Heart Failure Long‐Term Registry Investigators. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: The ESC Heart Failure Long‐Term Registry. Eur J Heart Fail 2017;19:1242–1254. https://doi.org/10.1002/ejhf.890
Filippatos G, Angermann CE, Cleland JGF, Lam CSP, Dahlström U, Dickstein K, et al. Global differences in characteristics, precipitants, and initial management of patients presenting with acute heart failure. JAMA Cardiol 2020;5:401–410. https://doi.org/10.1001/jamacardio.2019.5108
Metra M, Tomasoni D, Adamo M, Bayes‐Genis A, Filippatos G, Abdelhamid M, et al. Worsening of chronic heart failure: Definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023;25:776–791. https://doi.org/10.1002/ejhf.2874
Mentz RJ, Kjeldsen K, Rossi GP, Voors AA, Cleland JGF, Anker SD, et al. Decongestion in acute heart failure. Eur J Heart Fail 2014;16:471–482. https://doi.org/10.1002/ejhf.74
Ambrosy AP, Cerbin LP, Armstrong PW, Butler J, Coles A, DeVore AD, et al. Body weight change during and after hospitalization for acute heart failure: Patient characteristics, markers of congestion, and outcomes: Findings from the ASCEND‐HF trial. JACC Heart Fail 2017;5:1–13. https://doi.org/10.1016/j.jchf.2016.09.012
Izumida T, Imamura T, Koi T, Nakagaito M, Onoda H, Tanaka S, et al. Prognostic impact of residual pulmonary congestion assessed by remote dielectric sensing system in patients admitted for heart failure. ESC Heart Fail 2024;11:1443–1451. https://doi.org/10.1002/ehf2.14690
Boorsma EM, Ter Maaten JM, Damman K, Dinh W, Gustafsson F, Goldsmith S, et al. Congestion in heart failure: A contemporary look at physiology, diagnosis and treatment. Nat Rev Cardiol 2020;17:641–655. https://doi.org/10.1038/s41569‐020‐0379‐7
Nunez J, de la Espriella R, Rossignol P, Voors AA, Mullens W, Metra M, et al. Congestion in heart failure: A circulating biomarker‐based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology. Eur J Heart Fail 2022;24:1751–1766. https://doi.org/10.1002/ejhf.2664
Biegus J, Borlaug BA, Testani JM. Congestion and decongestion assessment in heart failure: Pressure, volume, or both? JACC Heart Fail 2023;11:1152–1156. https://doi.org/10.1016/j.jchf.2023.05.034
Sokolska JM, Sokolski M, Zymlinski R, Biegus J, Siwołowski P, Nawrocka‐Millward S, et al. Distinct clinical phenotypes of congestion in acute heart failure: Characteristics, treatment response, and outcomes. ESC Heart Fail 2020;7:3830–3840. https://doi.org/10.1002/ehf2.12973
Packer M. The neurohormonal hypothesis: A theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol 1992;20:248–254. https://doi.org/10.1016/0735‐1097(92)90167‐l
Fallick C, Sobotka PA, Dunlap ME. Sympathetically mediated changes in capacitance: Redistribution of the venous reservoir as a cause of decompensation. Circ Heart Fail 2011;4:669–675. https://doi.org/10.1161/CIRCHEARTFAILURE.111.961789
Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nat Rev Cardiol 2017;14:30–38. https://doi.org/10.1038/nrcardio.2016.163
Biegus J, Nawrocka‐Millward S, Zymlinski R, Fudim M, Testani J, Marciniak D, et al. Distinct renin/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure. Int J Cardiol 2021;345:54–60. https://doi.org/10.1016/j.ijcard.2021.10.149
Mullens W, Verbrugge FH, Nijst P, Tang WHW. Renal sodium avidity in heart failure: From pathophysiology to treatment strategies. Eur Heart J 2017;38:1872–1882. https://doi.org/10.1093/eurheartj/ehx035
Matsumoto S, Nakamura N, Konishi M, Shibata A, Kida K, Ishii S, et al. Neuroendocrine hormone status and diuretic response to atrial natriuretic peptide in patients with acute heart failure. ESC Heart Fail 2022;9:4077–4087. https://doi.org/10.1002/ehf2.14083
Honda S, Nagai T, Nishimura K, Nakai M, Honda Y, Nakano H, et al.; NaDEF Investigators. Long‐term prognostic significance of urinary sodium concentration in patients with acute heart failure. Int J Cardiol 2018;254:189–194. https://doi.org/10.1016/j.ijcard.2017.08.053
Biegus J, Zymlinski R, Sokolski M, Todd J, Cotter G, Metra M, et al. Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure. Eur J Heart Fail 2019;21:624–633. https://doi.org/10.1002/ejhf.1428
Biegus J, Zymlinski R, Testani J, Marciniak D, Zdanowicz A, Jankowska EA, et al. Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high‐risk acute heart failure patients. Eur J Heart Fail 2021;23:729–739. https://doi.org/10.1002/ejhf.2053
Zymlinski R, Sierpinski R, Metra M, Cotter G, Sokolski M, Siwołowski P, et al. Elevated plasma endothelin‐1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure. ESC Heart Fail 2020;7:3536–3544. https://doi.org/10.1002/ehf2.13064
Biegus J, Zymlinski R, Fudim M, Testani J, Sokolski M, Marciniak D, et al. Spot urine sodium in acute heart failure: Differences in prognostic value on admission and discharge. ESC Heart Fail 2021;8:2597–2602. https://doi.org/10.1002/ehf2.13372
Cox ZL, Rao VS, Ivey‐Miranda JB, Moreno‐Villagomez J, Mahoney D, Ponikowski P, et al. Compensatory post‐diuretic renal sodium reabsorption is not a dominant mechanism of diuretic resistance in acute heart failure. Eur Heart J 2021;42:4468–4477. https://doi.org/10.1093/eurheartj/ehab620
Pandhi P, Ter Maaten JM, Anker SD, Ng LL, Metra M, Samani NJ, et al. Pathophysiologic processes and novel biomarkers associated with congestion in heart failure. JACC Heart Fail 2022;10:623–632. https://doi.org/10.1016/j.jchf.2022.05.013
Iwanek G, Ponikowska B, Zdanowicz A, Fudim M, Hurkacz M, Zymliński R, et al. Relationship of vascular endothelial growth factor C, a lymphangiogenesis modulator, with edema formation, congestion and outcomes in acute heart failure. J Card Fail 2023;29:1629–1638. https://doi.org/10.1016/j.cardfail.2023.04.006
Salah HM, Biegus J, Fudim M. Role of the renal lymphatic system in heart failure. Curr Heart Fail Rep 2023;20:113–120. https://doi.org/10.1007/s11897‐023‐00595‐0
Egerstedt A, Czuba T, Bronton K, Lejonberg C, Ruge T, Wessman T, et al. Bioactive adrenomedullin for assessment of venous congestion in heart failure. ESC Heart Fail 2022;9:3543–3555. https://doi.org/10.1002/ehf2.14018
Vella A, Labate V, Carenini G, Alfonzetti E, Milani V, Bandera F, et al. Phenotyping congestion in acute heart failure by renal flow and right heart to pulmonary circulation coupling. ESC Heart Fail 2023;10:3546–3558. https://doi.org/10.1002/ehf2.14522
Menghoum N, Badii MC, Deltombe M, Lejeune S, Roy C, Vancraeynest D, et al. Carbohydrate antigen 125: A useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction. ESC Heart Fail 2024;11:1493–1505. https://doi.org/10.1002/ehf2.14699
Tomasoni D, Vishram‐Nielsen JKK, Pagnesi M, Adamo M, Lombardi CM, Gustafsson F, et al. Advanced heart failure: Guideline‐directed medical therapy, diuretics, inotropes, and palliative care. ESC Heart Fail 2022;9:1507–1523. https://doi.org/10.1002/ehf2.13859
Huang X, Dorhout Mees E, Vos P, Hamza S, Braam B. Everything we always wanted to know about furosemide but were afraid to ask. Am J Physiol Renal Physiol 2016;310:F958–F971. https://doi.org/10.1152/ajprenal.00476.2015
Seko Y, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, et al. Association between changes in loop diuretic dose and outcomes in acute heart failure. ESC Heart Fail 2023;10:1757–1770. https://doi.org/10.1002/ehf2.14338
Croset F, Llàcer P, Núñez J, Campos J, García M, Pérez A, et al. Loop diuretic down‐titration at discharge in patients hospitalized for acute heart failure. ESC Heart Fail 2024;11:1739–1747. https://doi.org/10.1002/ehf2.14749
Faris R, Flather M, Purcell H, Henein M, Poole‐Wilson P, Coats A. Current evidence supporting the role of diuretics in heart failure: A meta analysis of randomised controlled trials. Int J Cardiol 2002;82:149–158. https://doi.org/10.1016/s0167‐5273(01)00600‐3
Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, Cohn JN. Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med 1985;103:1–6. https://doi.org/10.7326/0003‐4819‐103‐1‐1
Bayliss J, Norell M, Canepa‐Anson R, Sutton G, Poole‐Wilson P. Untreated heart failure: Clinical and neuroendocrine effects of introducing diuretics. Br Heart J 1987;57:17–22. https://doi.org/10.1136/hrt.57.1.17
Boorsma EM, Beusekamp JC, Ter Maaten JM, Figarska SM, AHJ D, van Veldhuisen DJ, et al. Effects of empagliflozin on renal sodium and glucose handling in patients with acute heart failure. Eur J Heart Fail 2021;23:68–78. https://doi.org/10.1002/ejhf.2066
Martinez‐Maldonado M, Gely R, Tapia E, Benabe JE. Role of macula densa in diuretics‐induced renin release. Hypertension 1990;16:261–268. https://doi.org/10.1161/01.hyp.16.3.261
Biegus J, Zymlinski R, Testani J, Fudim M, Cox ZL, Guzik M, et al. The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure. Eur J Heart Fail 2023;25:1323–1333. https://doi.org/10.1002/ejhf.2852
Ikram H, Chan W, Espiner EA, Nicholls MG. Haemodynamic and hormone responses to acute and chronic frusemide therapy in congestive heart failure. Clin Sci (Lond) 1980;59:443–449. https://doi.org/10.1042/cs0590443
Kaissling B, Bachmann S, Kriz W. Structural adaptation of the distal convoluted tubule to prolonged furosemide treatment. Am J Physiol 1985;248:F374–F381. https://doi.org/10.1152/ajprenal.1985.248.3.F374
Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al.; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011;364:797–805. https://doi.org/10.1056/NEJMoa1005419
Mentz RJ, Anstrom KJ, Eisenstein EL, Sapp S, Greene SJ, Morgan S, et al.; TRANSFORM‐HF Investigators. Effect of torsemide vs furosemide after discharge on all‐cause mortality in patients hospitalized with heart failure: The TRANSFORM‐HF randomized clinical trial. JAMA 2023;329:214–223. https://doi.org/10.1001/jama.2022.23924
Eshaghian S, Horwich TB, Fonarow GC. Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 2006;97:1759–1764. https://doi.org/10.1016/j.amjcard.2005.12.072
Hasselblad V, Gattis Stough W, Shah MR, Lokhnygina Y, O'Connor CM, Califf RM, et al. Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE trial. Eur J Heart Fail 2007;9:1064–1069. https://doi.org/10.1016/j.ejheart.2007.07.011
Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, et al. Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation. ESC Heart Fail 2023;10:2843–2852. https://doi.org/10.1002/ehf2.14467
Mullens W, Dauw J, Martens P, Verbrugge FH, Nijst P, Meekers E, et al.; ADVOR Study Group. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med 2022;387:1185–1195. https://doi.org/10.1056/NEJMoa2203094
Bueno H, Packer M. Acetazolamide for acute heart failure: Is ADVOR a riddle wrapped in a mystery inside an enigma? Eur Heart J 2023;44:3683–3685. https://doi.org/10.1093/eurheartj/ehad560
Meekers E, Dauw J, Martens P, Dhont S, Verbrugge FH, Nijst P, et al. Renal function and decongestion with acetazolamide in acute decompensated heart failure: The ADVOR trial. Eur Heart J 2023;44:3672–3682. https://doi.org/10.1093/eurheartj/ehad557
Trullas JC, Morales‐Rull JL, Casado J, Carrera‐Izquierdo M, Sánchez‐Marteles M, Conde‐Martel A, et al.; CLOROTIC Trial Investigators. Combining loop with thiazide diuretics for decompensated heart failure: The CLOROTIC trial. Eur Heart J 2023;44:411–421. https://doi.org/10.1093/eurheartj/ehac689
Guzik M, Iwanek G, Fudim M, Zymliński R, Marciniak D, Ponikowski P, et al. Spot urine sodium as a marker of urine dilution and decongestive abilities in acute heart failure. Sci Rep 2024;14:1494. https://doi.org/10.1038/s41598‐024‐51744‐x
Ter Maaten JM, Beldhuis IE, van der Meer P, Krikken JA, Postmus D, Coster JE, et al. Natriuresis‐guided diuretic therapy in acute heart failure: A pragmatic randomized trial. Nat Med 2023;29:2625–2632. https://doi.org/10.1038/s41591‐023‐02532‐z
Dauw J, Charaya K, Lelonek M, Zegri‐Reiriz I, Nasr S, Paredes‐Paucar CP, et al. Protocolized natriuresis‐guided decongestion improves diuretic response: The multicenter ENACT‐HF study. Circ Heart Fail 2024;17:e011105. https://doi.org/10.1161/CIRCHEARTFAILURE.123.011105
Guzik M, Sokolski M, Hurkacz M, Zdanowicz A, Iwanek G, Marciniak D, et al. Serum osmolarity and vasopressin concentration in acute heart failure – influence on clinical course and outcome. Biomedicine 2022;10:2034. https://doi.org/10.3390/biomedicines10082034
Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al.; Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: The EVEREST outcome trial. JAMA 2007;297:1319–1331. https://doi.org/10.1001/jama.297.12.1319
Felker GM, Mentz RJ, Cole RT, Adams KF, Egnaczyk GF, Fiuzat M, et al. Efficacy and safety of tolvaptan in patients hospitalized with acute heart failure. J Am Coll Cardiol 2017;69:1399–1406. https://doi.org/10.1016/j.jacc.2016.09.004
Massie BM, O'Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, et al.; PROTECT Investigators and Committees. Rolofylline, an adenosine A1‐receptor antagonist, in acute heart failure. N Engl J Med 2010;363:1419–1428. https://doi.org/10.1056/NEJMoa0912613
Urban S, Blaziak M, Biegus J, Zymlinski R. Ultrafiltration in acute heart failure: Current knowledge and fields for further research. Adv Clin Exp Med 2021;30:737–746. https://doi.org/10.17219/acem/135347
Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al.; UNLOAD Trial Investigators. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2007;49:675–683. https://doi.org/10.1016/j.jacc.2006.07.073
Lopez‐Vilella R, Guerrero Cervera B, Sanchez‐Lazaro I, Donoso Trenado V, Soldevila Orient A, Devesa Such R, et al. Therapeutic approach in heart failure with poor diuretic response: Peripheral ultrafiltration vs. conventional treatment. ESC Heart Fail 2023;10:2290–2297. https://doi.org/10.1002/ehf2.14386
Bart BA, Goldsmith SR, Lee KL, Givertz MM, O'Connor CM, Bull DA, et al.; Heart Failure Clinical Research Network. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 2012;367:2296–2304. https://doi.org/10.1056/NEJMoa1210357
Mentz RJ, Stevens SR, DeVore AD, Lala A, Vader JM, AbouEzzeddine OF, et al. Decongestion strategies and renin‐angiotensin‐aldosterone system activation in acute heart failure. JACC Heart Fail 2015;3:97–107. https://doi.org/10.1016/j.jchf.2014.09.003
Costanzo MR, Ronco C, Abraham WT, Agostoni P, Barasch J, Fonarow GC, et al. Extracorporeal ultrafiltration for fluid overload in heart failure: Current status and prospects for further research. J Am Coll Cardiol 2017;69:2428–2445. https://doi.org/10.1016/j.jacc.2017.03.528
Hornych A, Safar M, Simon A, Levenson J, Bariety J, Milliez P. Effects of captopril on prostaglandin and natriuresis in patients with essential hypertension. Am J Cardiol 1982;49:1524–1526. https://doi.org/10.1016/0002‐9149(82)90376‐9
Daskalopoulos G, Pinzani M, Murray N, Hirschberg R, Zipser RD. Effects of captopril on renal function in patients with cirrhosis and ascites. J Hepatol 1987;4:330–336. https://doi.org/10.1016/s0168‐8278(87)80542‐1
Gentilini P, Romanelli RG, La Villa G, Maggiore Q, Pesciullesi E, Cappelli G, et al. Effects of low‐dose captopril on renal hemodynamics and function in patients with cirrhosis of the liver. Gastroenterology 1993;104:588–594. https://doi.org/10.1016/0016‐5085(93)90431‐b
Hensen J, Abraham WT, Durr JA, Schrier RW. Aldosterone in congestive heart failure: Analysis of determinants and role in sodium retention. Am J Nephrol 1991;11:441–446. https://doi.org/10.1159/000168356
Ferreira JP, Girerd N, Medeiros PB, Santos M, Carvalho HC, Bettencourt P, et al. Spot urine sodium excretion as prognostic marker in acutely decompensated heart failure: The spironolactone effect. Clin Res Cardiol 2016;105:489–507. https://doi.org/10.1007/s00392‐015‐0945‐x
Bauersachs J, Fraccarollo D, Ertl G, Gretz N, Wehling M, Christ M. Striking increase of natriuresis by low‐dose spironolactone in congestive heart failure only in combination with ACE inhibition: Mechanistic evidence to support RALES. Circulation 2000;102:2325–2328. https://doi.org/10.1161/01.cir.102.19.2325
van Vliet AA, Donker AJ, Nauta JJ, Verheugt FW. Spironolactone in congestive heart failure refractory to high‐dose loop diuretic and low‐dose angiotensin‐converting enzyme inhibitor. Am J Cardiol 1993;71:21A–28A. https://doi.org/10.1016/0002‐9149(93)90241‐4
Bakris GL, Hart P, Ritz E. Beta blockers in the management of chronic kidney disease. Kidney Int 2006;70:1905–1913. https://doi.org/10.1038/sj.ki.5001835
Dupont AG. Carvedilol and the kidney. Clin Investig 1992;70:S127–S131. https://doi.org/10.1007/BF00207623
Wuerzner G, Chiolero A, Maillard M, Nussberger J, Burnier M. Metoprolol prevents sodium retention induced by lower body negative pressure in healthy men. Kidney Int 2005;68:688–694. https://doi.org/10.1111/j.1523‐1755.2005.00447.x
Bohm M, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett ME, et al. Less loop diuretic use in patients on sacubitril/valsartan undergoing remote pulmonary artery pressure monitoring. ESC Heart Fail 2022;9:155–163. https://doi.org/10.1002/ehf2.13665
Chatur S, Claggett BL, Vardeny O, Jering K, Desai AS, Pfeffer MA, et al. Sacubitril/valsartan and loop diuretic requirement in heart failure with preserved ejection fraction in the PARAGON‐HF trial. Eur J Heart Fail 2023;25:87–94. https://doi.org/10.1002/ejhf.2703
Vardeny O, Claggett B, Kachadourian J, Desai AS, Packer M, Rouleau J, et al. Reduced loop diuretic use in patients taking sacubitril/valsartan compared with enalapril: The PARADIGM‐HF trial. Eur J Heart Fail 2019;21:337–341. https://doi.org/10.1002/ejhf.1402
Selvaraj S, Claggett B, Pozzi A, McMurray JJV, Jhund PS, Packer M, et al. Prognostic implications of congestion on physical examination among contemporary patients with heart failure and reduced ejection fraction: PARADIGM‐HF. Circulation 2019;140:1369–1379. https://doi.org/10.1161/CIRCULATIONAHA.119.039920
Jackson AM, Dewan P, Anand IS, Bělohlávek J, Bengtsson O, de Boer RA, et al. Dapagliflozin and diuretic use in patients with heart failure and reduced ejection fraction in DAPA‐HF. Circulation 2020;142:1040–1054. https://doi.org/10.1161/CIRCULATIONAHA.120.047077
Mentz RJ, Ward JH, Hernandez AF, Lepage S, Morrow DA, Sarwat S, et al.; PARAGLIDE‐HF Investigators. Angiotensin‐neprilysin inhibition in patients with mildly reduced or preserved ejection fraction and worsening heart failure. J Am Coll Cardiol 2023;82:1–12. https://doi.org/10.1016/j.jacc.2023.04.019
Mebazaa A, Davison BA, Biegus J, Edwards C, Murtagh G, Varounis C, et al. Reduced congestion and improved response to a fluid/sodium challenge in chronic heart failure patients after initiation of sacubitril/valsartan: The NATRIUM‐HF study. Eur J Heart Fail 2024;26:1507–1517. https://doi.org/10.1002/ejhf.3265
Mebazaa A, Davison BA, Biegus J, Murtagh G, Varounis C, Hayrapetyan H, et al. Reduced congestion and improvedresponse to a fluid/sodium challenge in chronic heart failure patients afterinitiation of sacubitril/valsartan: The NATRIUM‐HF study. Eur J Heart Fail 2024;26:1507–1517. https://doi.org/10.1002/ejhf.3265
Mebazaa A, Davison B, Chioncel O, Cohen‐Solal A, Diaz R, Filippatos G, et al. Safety, tolerability and efficacy of up‐titration of guideline‐directed medical therapies for acute heart failure (STRONG‐HF): A multinational, open‐label, randomised, trial. Lancet 2022;400:1938–1952. https://doi.org/10.1016/S0140‐6736(22)02076‐1
Biegus J, Mebazaa A, Davison B, Cotter G, Edwards C, Čelutkienė J, et al. Effects of rapid up‐titration of neurohormonal blockade on effective, sustainable decongestion and outcomes in STRONG‐HF. J Am Coll Cardiol 2024;84:323–336. https://doi.org/10.1016/j.jacc.2024.04.055
Bistola V, Simitsis P, Parissis J, Ouwerkerk W, van Veldhuisen DJ, Cleland JG, et al. Association between up‐titration of medical therapy and total hospitalizations and mortality in patients with recent worsening heart failure across the ejection fraction spectrum. Eur J Heart Fail 2021;23:1170–1181. https://doi.org/10.1002/ejhf.2219
Biegus J, Fudim M, Salah HM, Heerspink HJL, Voors AA, Ponikowski P. Sodium‐glucose cotransporter‐2 inhibitors in heart failure: Potential decongestive mechanisms and current clinical studies. Eur J Heart Fail 2023;25:1526–1536. https://doi.org/10.1002/ejhf.2967
Biegus J, Voors AA, Collins SP, Kosiborod MN, Teerlink JR, Angermann CE, et al. Impact of empagliflozin on decongestion in acute heart failure: The EMPULSE trial. Eur Heart J 2023;44:41–50. https://doi.org/10.1093/eurheartj/ehac530
Damman K, Beusekamp JC, Boorsma EM, Swart HP, Smilde TDJ, Elvan A, et al. Randomized, double‐blind, placebo‐controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA‐RESPONSE‐AHF). Eur J Heart Fail 2020;22:713–722. https://doi.org/10.1002/ejhf.1713
Packer M, Butler J, Zeller C, Pocock SJ, Brueckmann M, Ferreira JP, et al. Blinded withdrawal of long‐term randomized treatment with empagliflozin or placebo in patients with heart failure. Circulation 2023;148:1011–1022. https://doi.org/10.1161/CIRCULATIONAHA.123.065748
Butler J, Usman MS, Filippatos G, Ferreira JP, Böhm M, Brueckmann M, et al. Safety and efficacy of empagliflozin and diuretic use in patients with heart failure and preserved ejection fraction: A post hoc analysis of the EMPEROR‐Preserved trial. JAMA Cardiol 2023;8:640–649. https://doi.org/10.1001/jamacardio.2023.1090
Chatur S, Vaduganathan M, Claggett B, Vardeny O, Desai AS, Jhund PS, et al. Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: The DELIVER trial. Eur Heart J 2023;44:2930–2943. https://doi.org/10.1093/eurheartj/ehad283
Kim SJ, Kim BJ, Im SI, Kim HS, Heo JH. Effects of empagliflozin on diuretics reduction in outpatient heart failure patients. Int J Heart Fail 2022;4:183–192. https://doi.org/10.36628/ijhf.2022.0009
Shah SJ, Sharma K, Borlaug BA, Butler J, Davies M, Kitzman DW, et al. Semaglutide and diuretic use in obesity‐related heart failure with preserved ejection fraction: A pooled analysis of the STEP‐HFpEF and STEP‐HFpEF‐DM trials. Eur Heart J 2024. https://doi.org/10.1093/eurheartj/ehae322 Published online ahead of print 13/05/24.
Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner‐la Rocca HP, Martens P, et al. The use of diuretics in heart failure with congestion – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019;21:137–155. https://doi.org/10.1002/ejhf.1369
Givertz MM, Stevenson LW, Costanzo MR, Bourge RC, Bauman JG, Ginn G, et al.; CHAMPION Trial Investigators. Pulmonary artery pressure‐guided management of patients with heart failure and reduced ejection fraction. J Am Coll Cardiol 2017;70:1875–1886. https://doi.org/10.1016/j.jacc.2017.08.010
Costanzo MR, Stevenson LW, Adamson PB, Desai AS, Heywood JT, Bourge RC, et al. Interventions linked to decreased heart failure hospitalizations during ambulatory pulmonary artery pressure monitoring. JACC Heart Fail 2016;4:333–344. https://doi.org/10.1016/j.jchf.2015.11.011
Kim GH. Long‐term adaptation of renal ion transporters to chronic diuretic treatment. Am J Nephrol 2004;24:595–605. https://doi.org/10.1159/000082314
Marton A, Saffari SE, Rauh M, Sun RN, Nagel AM, Linz P, et al. Water conservation overrides osmotic diuresis during SGLT2 inhibition in patients with heart failure. J Am Coll Cardiol 2024;83:1386–1398. https://doi.org/10.1016/j.jacc.2024.02.020
Biegus J, Moayedi Y, Saldarriaga C, Ponikowski P. Getting ahead of the game: In‐hospital initiation of HFrEF therapies. Eur Heart J Suppl 2022;24:L38–L44. https://doi.org/10.1093/eurheartjsupp/suac120