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Impact of Loop Diuretic on Outcomes in Patients with Heart Failure and Reduced Ejection Fraction

  • Clinical Heart Failure (T. Meyer, Section Editor)
  • Published:
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Abstract

Purpose of Review

Loop diuretics are the cornerstone of the treatment of congestion in heart failure patients. The manuscript aims to summarize the most updated information regarding the use of loop diuretics in heart failure.

Recent Findings

Diuretic response can be highly variable between patients and needs to be carefully evaluated during and after the hospitalization. Diuretic resistance can lead to residual congestion which affects prognosis and can be difficult to detect. The effect of loop diuretics on long-term prognosis remains uncertain but patients with advanced heart failure typically have renal dysfunction and are more inclined to develop loop diuretic resistance, which may lead to an incomplete decongestion and thus to a worse prognosis.

Summary

Loop diuretics are the most potent diuretics available and their use is recommended in order to alleviate symptoms, improve exercise capacity, and reduce hospitalizations in patients with heart failure. Their use should be limited to the lowest dose necessary to maintain euvolemia because a low dose does not increase the risk of decompensation but reduce the risk of adverse effects and allow the up-titration of disease-modifying drugs.

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Authors and Affiliations

  1. Cardiology division, University of Verona, Verona, Italy

    Cicoira Maria Antonietta, Caterina Maffeis & Marco De Stefano

  2. Cardiology Division, University of Brescia, Brescia, Italy

    Emiliano Calvi & Marco Bosisio

  3. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Cardiology Unit, University of Milan, Milan, Italy

    Andrea Faggiano & Stefano Carugo

  4. Cardiovascular Department, Fondazione Poliambulanza, Brescia, Italy

    Pompilio Faggiano

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  1. Cicoira Maria Antonietta
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  2. Emiliano Calvi
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  3. Andrea Faggiano
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  4. Caterina Maffeis
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  6. Marco De Stefano
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Correspondence to Pompilio Faggiano.

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Antonietta, C.M., Calvi, E., Faggiano, A. et al. Impact of Loop Diuretic on Outcomes in Patients with Heart Failure and Reduced Ejection Fraction. Curr Heart Fail Rep 19, 15–25 (2022). https://doi.org/10.1007/s11897-021-00538-7

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