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Inpatient Diuretic Management of Acute Heart Failure: A Practical Review

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Abstract

The inpatient treatment of acute heart failure (AHF) is aimed at achieving euvolemia, relieving symptoms, and reducing rehospitalization. Adequate treatment of AHF is rooted in understanding the pharmacokinetics and pharmacodynamics of select diuretic agents used to achieve decongestion. While loop diuretics remain the primary treatment of AHF, the dosing strategies of loop diuretics and the use of adjunct diuretic classes to augment clinical response can be complex. This review examines the latest strategies for diuretic management in patients with AHF, including dosing and monitoring strategies, interaction of diuretics with other medication classes, use adjunctive therapies, and assessing endpoints for diuretic. The goal of the review is to guide the reader through commonly encountered clinical scenarios and pitfalls in the diuretic management of patients with AHF.

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  1. Division of Cardiology, Loma Linda University School of Medicine, 11234 Anderson Street, Schuman Pavilion, SP-1617, Loma Linda, CA, 92354, USA

    Saif Ali, Sharon Jung, Shuktika Nandkeolyar, Liset Stoletniy, Antoine Sakr, Anthony Hilliard & Dmitry Abramov

  2. Centre for Cardiovascular Diseases, University Hospital Brussels, Brussels, Belgium

    Frederik H. Verbrugge

  3. Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

    Frederik H. Verbrugge

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Frederik H.Verbrugge is supported by the Special Research Fund (BOF) of Hasselt University (BOF19PD04).

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Saif Ali, Sharon Jung, Shuktika Nandkeolyar, Liset Stoletniy, Antoine Sakr, Anthony Hilliard, Frederik H. Verbrugge and Dmitry Abramov declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript. Frederik H. Verbrugge is supported by the Special Research Fund (BOF) of Hasselt University (BOF19PD04).

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Ali, S., Jung, S., Nandkeolyar, S. et al. Inpatient Diuretic Management of Acute Heart Failure: A Practical Review. Am J Cardiovasc Drugs 21, 595–608 (2021). https://doi.org/10.1007/s40256-020-00463-5

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