ABC Heart Fail Cardiomyop 2022; 2(1): 94-98

Diuretics In Stable Outpatients with Mild Heart Failure – May I Discontinue Them?

Marciane Maria Rover , Aline Coletto Jaccottet, Diether Villegas Calle, Roberto Tofani Sant´Anna

DOI: 10.36660/abchf.20220019

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 are administered alone or in combination with other drugs, diuretics improve functional capacity and quality-of-life scores by reducing preload, ventricular filling pressures, and mitral regurgitation, resulting in increased cardiac output.

Congestion assessment is essential in diuretic optimization. Within this context, we should consider the low accuracy of clinical signs of congestion, especially when these signs are used alone. Conversely, concomitant assessment of several factors – including New York Heart Association (NYHA) functional class, orthopnea or paroxysmal nocturnal dyspnea, edema, pulmonary rales, third heart sound, hepatojugular reflux, and jugular venous distension – can identify patients at higher risk when they are grouped together by congestion scores. Additional tests increase predictive value and contribute to decision-making. The most common methods are serum natriuretic peptide measurement and imaging tests such as chest radiography, lung ultrasound, and echocardiography. They may be considered before diuretic discontinuation and for monitoring blood volume, especially in doubtful cases.

[…]