Abstract Background Few studies compared different sodium (Na) diets associated with high furosemide doses (FHD) and fluid intake restriction (FIR) on the PCWC in compensated heart failure (HF) patients. Objectives The study was aimed to verify FHD effects, 120 mmol/Na/day and FIR (1.000 ml day) vs FHD, FIR, and 80 mmol/Na/day on the PCWP, during 12 months of follow-up. Methods 289 patients with HF were randomized: Group A (n =146) received 120 mmol Na/day, FIR, and 125-250 mg bid of […]

Abstract Heart failure is a highly prevalent syndrome worldwide, including in Latin America, where prevalence rates are estimated at 1.2% to 2.1% of the population. This reality is no different in Brazil, where the syndrome is estimated to affect approximately 2% of the adult population, leading to an overwhelming financial impact of approximately 28.1 billion Brazilian reals in 2015 alone, when the total costs to society and the health system were measured. As if the broad economic impact were not […]

There has been remarkable progress in the treatment of heart failure (HF) over the past years. Medications such as angiotensin receptor-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors (SGLT2i), often referred to as the “fantastic four,” have been shown to reduce mortality and hospitalization, in addition to improving patients’ quality of life. The natural history of the disease is characterized by recurrent episodes of decompensation and hospital admission linked to pulmonary and/or systemic congestion. Although diuretics […]

Abstract The administration of hypertonic saline (HS) in decompensated heart failure (HF) seems counterintuitive, given the concept that sodium is universally harmful for these patients. However, increasingly, strict sodium restrictions have been questioned due to the lack of proven benefits. On the other hand, we know that in acute HF complicated with diuretic resistance, there is hyperactivation of the renin-angiotensin-aldosterone system (RAAS), resulting in a state of excessive increase in renal avidity for sodium, hindering the action of loop diuretics. […]

Abstract Heart failure (HF) is a progressive condition, characterized by variable periods of symptomatic stability frequently interrupted by episodes of A worsening condition. These moments of clinical deterioration have been recognized as a distinct phase in the course of HF and indicate a considerably worse prognosis. Preventing readmissions of patients with HF is a growing priority for medical providers, researchers, and healthcare managers. Although evidence-based therapies for treating patients with HF have increased, consistent implementation of these therapies and the […]

Persistent congestion despite the use of loop diuretics (LD) is one of the most important challenges in the management of acute heart failure (HF) and is associated with a worse prognosis. One of the main reasons for this persistence in congestion is resistance to LD, which can be defined as a reduction in sensitivity to diuretics, with reduced natriuresis and diuresis and limitation of reaching euvolemia – LD can reach up to 1/3 of patients admitted for acute HF and […]

Abstract Worsening congestion is the main reason for hospitalization of most acute heart failure (AHF) patients. However, most patients are discharged with residual congestion, resulting in early readmissions that portend poor outcomes. Diuretics remain the mainstay of therapy. Nevertheless, these drugs stimulate the renin-angiotensin–aldosterone (RAA) axis and the sympathetic system and elicit adaptive responses in the nephron that may be counterproductive and lead to diuretic resistance. Renal failure and AHF are common and coexist in up to 40% of cases. […]

Heart failure: congestion and diuretic therapy Congestion is a key component of the pathophysiology of heart failure (HF) and causes some of the cardinal symptoms of the disease, such as edema, orthopnea, and dyspnea on exertion. Congestion management is, therefore, of utmost importance for a successful HF treatment. Management is based on the prescription of loop diuretics for symptomatic patients according to different guidelines, although there are no placebo-controlled studies that support their use for reducing mortality. , When they […]

Abstract Heart failure is the leading cause of hospitalization in patients over 65 years of age, and, in most cases, patients present with signs and symptoms of congestion. Thus, diuretics play a prominent role and are among the most used drugs in heart failure. Although they have been used for decades, the lack of large controlled studies in the literature to support their use more adequately and the eventual development of resistance/tolerance are among the factors that make management of […]

Abstract Heart failure is a syndrome with variable presentations; congestion is the most common form in acutely decompensated patients. In this scenario, the main drug to resolve congestion is a loop diuretic. However, a portion of the population has diuretic resistance. In this context, adjuvant diuretic therapies are needed to resolve congestion in patients with heart failure. The main strategies studied so far are thiazide diuretics, mineralocorticoid receptors antagonists, vasopressin antagonists, nesiritide, sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, hypertonic saline, and […]