Heart Failure Reviews

, Volume 24, Issue 1, pp 17–30 | Cite as

Loop diuretics in chronic heart failure: how to manage congestion?

  • Justas SimonavičiusEmail author
  • Christian Knackstedt
  • Hans-Peter Brunner-La Rocca


Loop diuretics remain the cornerstone of congestion management in contemporary chronic heart failure care. However, their use is not supported by high quality data, and there is doubt about the safety in the outpatient heart failure setting. Still, congestion is related to a worse outcome, and there is general consensus among experts that congestion should not be tolerated in heart failure patients. Recommendations in international guidelines, regarding decongestion strategies in chronic heart failure, are limited. Thus, there is an emerging need for clinical decision-making support about the best strategy for using loop diuretics and decongestion in the chronic setting. The present review provides a comprehensive overview over the evidence of chronic loop diuretic use. Strategies for the assessment of congestion in the outpatient setting and decongestion algorithm are provided to assist health care specialists in delivering high-quality heart failure care.


Chronic heart failure Volume overload Decongestion Loop diuretic Diuretic therapy Diuretic resistance 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10741_2018_9735_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)


  1. 1.
    DeVore Adam D, Vic H, Mentz RJ et al (2015) Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF. Eur J Heart Fail 17:340–346. CrossRefPubMedGoogle Scholar
  2. 2.
    Pfisterer M, Buser P, Rickli H, Gutmann M, Erne P, Rickenbacher P, Vuillomenet A, Jeker U, Dubach P, Beer H, Yoon SI, Suter T, Osterhues HH, Schieber MM, Hilti P, Schindler R, Brunner-la Rocca HP, TIME-CHF Investigators (2009) BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial. JAMA 301:383–392. CrossRefPubMedGoogle Scholar
  3. 3.
    Rodriguez-Cillero C, Menu D, d’Athis P, et al (2017) Potentially inappropriate use of furosemide in a very elderly population: an observational study. Int J Clin Pract 71. doi:
  4. 4.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200. CrossRefPubMedGoogle Scholar
  5. 5.
    Yancy CW, Jessup M, Bozkurt B et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 128:e240–e327. CrossRefPubMedGoogle Scholar
  6. 6.
    Faris RF, Flather M, Purcell H, et al (2012) Diuretics for heart failure. Cochrane Database Syst Rev CD003838. doi:
  7. 7.
    Yancy CW, Jessup M, Bozkurt B et al (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation.
  8. 8.
    Martens P, Verbrugge FH, Nijst P, Dupont M, Mullens W (2017) Changes in loop diuretic dose and outcome after cardiac resynchronization therapy in patients with heart failure and reduced left ventricular ejection fractions. Am J Cardiol 120:267–273. CrossRefPubMedGoogle Scholar
  9. 9.
    Eshaghian S, Horwich TB, Fonarow GC (2006) Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 97:1759–1764. CrossRefPubMedGoogle Scholar
  10. 10.
    Abdel-Qadir HM, Tu JV, Yun L et al (2010) Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization. Am Heart J 160:264–271.e1. CrossRefPubMedGoogle Scholar
  11. 11.
    Martins J, Lourenço P, Araújo JP, Mascarenhas J, Lopes R, Azevedo A, Bettencourt P (2011) Prognostic implications of diuretic dose in chronic heart failure. J Cardiovasc Pharmacol Ther 16:185–191. CrossRefPubMedGoogle Scholar
  12. 12.
    Dini FL, Guglin M, Simioniuc A, Donati F, Fontanive P, Pieroni A, Orsini E, Caravelli P, Marzilli M (2012) Association of furosemide dose with clinical status, left ventricular dysfunction, natriuretic peptides, and outcome in clinically stable patients with chronic systolic heart failure. Congest Heart Fail 18:98–106. CrossRefPubMedGoogle Scholar
  13. 13.
    Neuberg GW, Miller AB, O’Connor CM et al (2002) Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J 144:31–38CrossRefGoogle Scholar
  14. 14.
    Damman K, Kjekshus J, Wikstrand J, Cleland JGF, Komajda M, Wedel H, Waagstein F, McMurray JJV (2016) Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction. Eur J Heart Fail 18:328–336. CrossRefPubMedGoogle Scholar
  15. 15.
    Ahmed A, Young JB, Love TE, Levesque R, Pitt B (2008) A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol 125:246–253. CrossRefPubMedGoogle Scholar
  16. 16.
    Ahmed A, Husain A, Love TE, Gambassi G, Dell'Italia LJ, Francis GS, Gheorghiade M, Allman RM, Meleth S, Bourge RC (2006) Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 27:1431–1439. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dini FL, Ghio S, Klersy C, Rossi A, Simioniuc A, Scelsi L, Genta FT, Cicoira M, Tavazzi L, Temporelli PL (2013) Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis. Int J Clin Pract 67:656–664. CrossRefPubMedGoogle Scholar
  18. 18.
    Hamaguchi S, Kinugawa S, Tsuchihashi-Makaya M et al (2012) Loop diuretic use at discharge is associated with adverse outcomes in hospitalized patients with heart failure: a report from the Japanese cardiac registry of heart failure in cardiology (JCARE-CARD). Circ J 76:1920–1927CrossRefGoogle Scholar
  19. 19.
    Schartum-Hansen H, Løland KH, Svingen GFT, et al (2015) Use of loop diuretics is associated with increased mortality in patients with suspected coronary artery disease, but without systolic heart failure or renal impairment: an observational study using propensity score matching. PLoS ONE 10. doi:
  20. 20.
    Hamaguchi S, Kinugawa S, Goto D et al (2011) Predictors of long-term adverse outcomes in elderly patients over 80 years hospitalized with heart failure. - A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 75:2403–2410CrossRefGoogle Scholar
  21. 21.
    Andersson C, Norgaard ML, Hansen PR, Fosbøl EL, Schmiegelow M, Weeke P, Olesen JB, Raunsø J, Jørgensen CH, Vaag A, Køber L, Torp-Pedersen C, Gislason GH (2010) Heart failure severity, as determined by loop diuretic dosages, predicts the risk of developing diabetes after myocardial infarction: a nationwide cohort study. Eur J Heart Fail 12:1333–1338. CrossRefPubMedGoogle Scholar
  22. 22.
    Nguyen T-L, Collins GS, Spence J, Daurès JP, Devereaux PJ, Landais P, le Manach Y (2017) Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance. BMC Med Res Methodol 17:78. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Austin PC (2007) Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thorac Cardiovasc Surg 134:1128–1135.e3. CrossRefPubMedGoogle Scholar
  24. 24.
    Ali MS, Groenwold RHH, Belitser SV, Pestman WR, Hoes AW, Roes KCB, Boer A, Klungel OH (2015) Reporting of covariate selection and balance assessment in propensity score analysis is suboptimal: a systematic review. J Clin Epidemiol 68:122–131. CrossRefGoogle Scholar
  25. 25.
    King G, Nielsen R (2016) Why propensity scores should not be used for matching. Gary King Website. Accessed 29 Aug 2018
  26. 26.
    Weber KT (2004) Furosemide in the long-term management of heart failure: the good, the bad, and the uncertain **editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 44:1308–1310. CrossRefPubMedGoogle Scholar
  27. 27.
    Huang X, Dorhout Mees E, Vos P, Hamza S, Braam B (2016) Everything we always wanted to know about furosemide but were afraid to ask. Am J Physiol Ren Physiol 310:F958–F971. CrossRefGoogle Scholar
  28. 28.
    van Kraaij DJW, Jansen RWMM, Sweep FCGJ, Hoefnagels WHL (2003) Neurohormonal effects of furosemide withdrawal in elderly heart failure patients with normal systolic function. Eur J Heart Fail 5:47–53CrossRefGoogle Scholar
  29. 29.
    Ellison DH, Felker GM (2017) Diuretic treatment in heart failure. N Engl J Med 377:1964–1975. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Cooper HA, Dries DL, Davis CE, Shen YL, Domanski MJ (1999) Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction. Circulation 100:1311–1315. CrossRefPubMedGoogle Scholar
  31. 31.
    Harjola V-P, Mullens W, Banaszewski M, Bauersachs J, Brunner-la Rocca HP, Chioncel O, Collins SP, Doehner W, Filippatos GS, Flammer AJ, Fuhrmann V, Lainscak M, Lassus J, Legrand M, Masip J, Mueller C, Papp Z, Parissis J, Platz E, Rudiger A, Ruschitzka F, Schäfer A, Seferovic PM, Skouri H, Yilmaz MB, Mebazaa A (2017) Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 19:821–836. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Katta N, Balla S, Alpert MA (2016) Does long-term furosemide therapy cause thiamine deficiency in patients with heart failure? A focused review. Am J Med 129:753.e7–753.e11. CrossRefGoogle Scholar
  33. 33.
    Zenuk C, Healey J, Donnelly J et al (2003) Thiamine deficiency in congestive heart failure patients receiving long term furosemide therapy. Can J Clin Pharmacol 10:184–188PubMedGoogle Scholar
  34. 34.
    House AA, Haapio M, Lassus J et al (2010) Therapeutic strategies for heart failure in cardiorenal syndromes. Am J Kidney Dis 56:759–773. CrossRefPubMedGoogle Scholar
  35. 35.
    Matsuo Y, Kasama S, Toyama T, Funada R, Takama N, Koitabashi N, Ichikawa S, Suzuki Y, Matsumoto N, Sato Y, Kurabayashi M (2016) Comparative effects of long-acting and short-acting loop diuretics on cardiac sympathetic nerve activity in patients with chronic heart failure. Open Heart 3:e000276. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kasama S, Toyama T, Hatori T, Sumino H, Kumakura H, Takayama Y, Ichikawa S, Suzuki T, Kurabayashi M (2006) Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodelling in patients with congestive heart failure. Heart 92:1434–1440. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Kaye DM, Jennings GL, Dart AM, Esler MD (1998) Differential effect of acute baroreceptor unloading on cardiac and systemic sympathetic tone in congestive heart failure. J Am Coll Cardiol 31:583–587CrossRefGoogle Scholar
  38. 38.
    Coats AJ (2001) A sympathetic heart and the art of dying. Eur Heart J 22:1069–1071. CrossRefPubMedGoogle Scholar
  39. 39.
    Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WHW (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53:589–596. CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Mullens W, Abrahams Z, Skouri HN, Francis GS, Taylor DO, Starling RC, Paganini E, Tang WHW (2008) Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 51:300–306. CrossRefPubMedGoogle Scholar
  41. 41.
    Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Verdiani V, Tijssen JG, Pinto YM (2015) Competing risk of cardiac status and renal function during hospitalization for acute decompensated heart failure. JACC Heart Fail 3:751–761. CrossRefPubMedGoogle Scholar
  42. 42.
    Tanaka H, Watanabe K, Harima M et al (2009) Effects of various diuretics on cardiac function in rats with heart failure. Yakugaku Zasshi 129:871–879CrossRefGoogle Scholar
  43. 43.
    Wargo KA, Banta WM (2009) A comprehensive review of the loop diuretics: should furosemide be first line? Ann Pharmacother 43:1836–1847. CrossRefPubMedGoogle Scholar
  44. 44.
    Murray MD, Deer MM, Ferguson JA, Dexter PR, Bennett SJ, Perkins SM, Smith FE, Lane KA, Adams LD, Tierney WM, Brater DC (2001) Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure. Am J Med 111:513–520CrossRefGoogle Scholar
  45. 45.
    Müller K, Gamba G, Jaquet F, Hess B (2003) Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV--efficacy and quality of life. Eur J Heart Fail 5:793–801CrossRefGoogle Scholar
  46. 46.
    Cosín J, Díez J, TORIC investigators (2002) Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 4:507–513CrossRefGoogle Scholar
  47. 47.
    Luo J, Chen X, Luo C, et al (2017) Hydrochlorothiazide modulates ischemic heart failure-induced cardiac remodeling via inhibiting angiotensin II type 1 receptor pathway in rats. Cardiovasc Ther 35. doi:
  48. 48.
    McCurley JM, Hanlon SU, Wei S et al (2004) Furosemide and the progression of left ventricular dysfunction in experimental heart failure. J Am Coll Cardiol 44:1301–1307. CrossRefPubMedGoogle Scholar
  49. 49.
    Rokutan H, Suckow C, von Haehling S, Strassburg S, Bockmeyer B, Doehner W, Waller C, Bauersachs J, von Websky K, Hocher B, Anker SD, Springer J (2012) Furosemide induces mortality in a rat model of chronic heart failure. Int J Cardiol 160:20–25. CrossRefPubMedGoogle Scholar
  50. 50.
    Seeland U, Kouchi I, Zolk O, Itter G, Linz W, Böhm M (2002) Effect of ramipril and furosemide treatment on interstitial remodeling in post-infarction heart failure rat hearts. J Mol Cell Cardiol 34:151–163. CrossRefPubMedGoogle Scholar
  51. 51.
    Seeland U, Kouchi I, Zolk O, Jockenhövel F, Itter G, Linz W, Böhm M (2003) Effects of diuretic treatment on cardiac and circulating RAS in chronic heart failure post-myocardial infarction in rats. Eur J Heart Fail 5:241–246CrossRefGoogle Scholar
  52. 52.
    Girerd N, Seronde M-F, Coiro S, Chouihed T, Bilbault P, Braun F, Kenizou D, Maillier B, Nazeyrollas P, Roul G, Fillieux L, Abraham WT, Januzzi J Jr, Sebbag L, Zannad F, Mebazaa A, Rossignol P, INI-CRCT, Great Network, and the EF-HF Group (2017) Integrative assessment of congestion in heart failure throughout the patient journey. JACC Heart Fail 6:273–285. CrossRefPubMedGoogle Scholar
  53. 53.
    Miller WL (2016) Fluid volume overload and congestion in heart failure: time to reconsider pathophysiology and how volume is assessed. Circ Heart Fail 9:e002922. CrossRefPubMedGoogle Scholar
  54. 54.
    Piano MR, Prasun MA, Stamos T, Groo V (2011) Flexible diuretic titration in chronic heart failure: where is the evidence? J Card Fail 17:944–954. CrossRefPubMedGoogle Scholar
  55. 55.
    Chaudhry SI, Mattera JA, Curtis JP, Spertus JA, Herrin J, Lin Z, Phillips CO, Hodshon BV, Cooper LS, Krumholz HM (2010) Telemonitoring in patients with heart failure. N Engl J Med 363:2301–2309. CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Fortes MB, Owen JA, Raymond-Barker P, Bishop C, Elghenzai S, Oliver SJ, Walsh NP (2015) Is this elderly patient dehydrated? Diagnostic accuracy of hydration assessment using physical signs, urine, and saliva markers. J Am Med Dir Assoc 16:221–228. CrossRefPubMedGoogle Scholar
  57. 57.
    Ritzema JL, Richards AM, Crozier IG, Frampton CF, Melton IC, Doughty RN, Stewart JT, Eigler N, Whiting J, Abraham WT, Troughton RW (2011) Serial Doppler echocardiography and tissue Doppler imaging in the detection of elevated directly measured left atrial pressure in ambulant subjects with chronic heart failure. J Am Coll Cardiol Img 4:927–934. CrossRefGoogle Scholar
  58. 58.
    Porter TR, Shillcutt SK, Adams MS, Desjardins G, Glas KE, Olson JJ, Troughton RW (2015) Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr 28:40–56. CrossRefPubMedGoogle Scholar
  59. 59.
    Rohde LE, Palombini DV, Polanczyk CA, Goldraich LA, Clausell N (2007) A hemodynamically oriented echocardiography-based strategy in the treatment of congestive heart failure. J Card Fail 13:618–625. CrossRefPubMedGoogle Scholar
  60. 60.
    Simioniuc A, Carluccio E, Ghio S, Rossi A, Biagioli P, Reboldi G, Galeotti GG, Lu F, Zara C, Whalley G, Temporelli PL, Dini FL, investigators of the Network Labs Ultrasound (NEBULA) in Heart Failure Study Group (2016) Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: an observational study of 1137 outpatients. Int J Cardiol 224:416–423. CrossRefPubMedGoogle Scholar
  61. 61.
    Davies SJ, Davenport A (2014) The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int 86:489–496. CrossRefPubMedGoogle Scholar
  62. 62.
    Shochat MK, Shotan A, Blondheim DS, Kazatsker M, Dahan I, Asif A, Rozenman Y, Kleiner I, Weinstein JM, Frimerman A, Vasilenko L, Meisel SR (2016) Non-invasive lung IMPEDANCE-guided preemptive treatment in chronic heart failure patients: a randomized controlled trial (IMPEDANCE-HF trial). J Card Fail 22:713–722. CrossRefPubMedGoogle Scholar
  63. 63.
    Conraads VM, Tavazzi L, Santini M, Oliva F, Gerritse B, Yu CM, Cowie MR (2011) Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J 32:2266–2273. CrossRefPubMedGoogle Scholar
  64. 64.
    Böhm M, Drexler H, Oswald H, Rybak K, Bosch R, Butter C, Klein G, Gerritse B, Monteiro J, Israel C, Bimmel D, Käab S, Huegl B, Brachmann J, OptiLink HF Study Investigators (2016) Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J 37:3154–3163. CrossRefPubMedGoogle Scholar
  65. 65.
    Gastelurrutia P, Cuba-Gyllensten I, Lupon J, Zamora E, Llibre C, Caballero Á, Riistama J, Aarts R, Bayes-Genis A (2016) Wearable vest for pulmonary congestion tracking and prognosis in heart failure: a pilot study. Int J Cardiol 215:77–79. CrossRefPubMedGoogle Scholar
  66. 66.
    Miglioranza MH, Gargani L, Sant’Anna RT et al (2013) Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. J Am Coll Cardiol Img 6:1141–1151. CrossRefGoogle Scholar
  67. 67.
    Pivetta E, Goffi A, Lupia E, Tizzani M, Porrino G, Ferreri E, Volpicelli G, Balzaretti P, Banderali A, Iacobucci A, Locatelli S, Casoli G, Stone MB, Maule MM, Baldi I, Merletti F, Cibinel GA, Baron P, Battista S, Buonafede G, Busso V, Conterno A, del Rizzo P, Ferrera P, Pecetto PF, Moiraghi C, Morello F, Steri F, Ciccone G, Calasso C, Caserta MA, Civita M, Condo' C, D'Alessandro V, del Colle S, Ferrero S, Griot G, Laurita E, Lazzero A, Lo Curto F, Michelazzo M, Nicosia V, Palmari N, Ricchiardi A, Rolfo A, Rostagno R, Bar F, Boero E, Frascisco M, Micossi I, Mussa A, Stefanone V, Agricola R, Cordero G, Corradi F, Runzo C, Soragna A, Sciullo D, Vercillo D, Allione A, Artana N, Corsini F, Dutto L, Lauria G, Morgillo T, Tartaglino B, Bergandi D, Cassetta I, Masera C, Garrone M, Ghiselli G, Ausiello L, Barutta L, Bernardi E, Bono A, Forno D, Lamorte A, Lison D, Lorenzati B, Maggio E, Masi I, Maggiorotto M, Novelli G, Panero F, Perotto M, Ravazzoli M, Saglio E, Soardo F, Tizzani A, Tizzani P, Tullio M, Ulla M, Romagnoli E, SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont (2015) Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest 148:202–210. CrossRefPubMedGoogle Scholar
  68. 68.
    Dini FL, Carluccio E, Montecucco F, et al (2017) Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: a position paper. Eur J Clin Invest 47. doi:
  69. 69.
    Abraham WT, Adamson PB, Bourge RC, Aaron MF, Costanzo MR, Stevenson LW, Strickland W, Neelagaru S, Raval N, Krueger S, Weiner S, Shavelle D, Jeffries B, Yadav JS (2011) Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 377:658–666. CrossRefPubMedGoogle Scholar
  70. 70.
    Abraham WT, Stevenson LW, Bourge RC, Lindenfeld JA, Bauman JG, Adamson PB (2016) Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart failure therapy: complete follow-up results from the CHAMPION randomised trial. Lancet 387:453–461. CrossRefPubMedGoogle Scholar
  71. 71.
    Adamson PB, Abraham WT, Stevenson LW, et al (2016) Pulmonary artery pressure-guided heart failure management reduces 30-day readmissions. Circ Heart Fail 9. doi:
  72. 72.
    Martinson M, Bharmi R, Dalal N, Abraham WT, Adamson PB (2017) Pulmonary artery pressure-guided heart failure management: US cost-effectiveness analyses using the results of the CHAMPION clinical trial. Eur J Heart Fail 19:652–660. CrossRefPubMedGoogle Scholar
  73. 73.
    Breidthardt T, Weidmann ZM, Twerenbold R, Gantenbein C, Stallone F, Rentsch K, Rubini Gimenez M, Kozhuharov N, Sabti Z, Breitenbücher D, Wildi K, Puelacher C, Honegger U, Wagener M, Schumacher C, Hillinger P, Osswald S, Mueller C (2017) Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function. Eur J Heart Fail 19:226–236. CrossRefPubMedGoogle Scholar
  74. 74.
    Vaduganathan M, Greene SJ, Fonarow GC, Voors AA, Butler J, Gheorghiade M (2014) Hemoconcentration-guided diuresis in heart failure. Am J Med 127:1154–1159. CrossRefPubMedGoogle Scholar
  75. 75.
    Alvarez AM, Mukherjee D (2011) Liver abnormalities in cardiac diseases and heart failure. Int J Angiol 20:135–142. CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Čerlinskaitė K, Javanainen T, Cinotti R, Mebazaa A, on behalf of the Global Research on Acute Conditions Team (GREAT) Network (2018) Acute heart failure management. Korean Circ J 48:463–480. CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Samsky MD, Dunning A, DeVore AD et al (2016) Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF. Eur J Heart Fail 18:424–432. CrossRefPubMedGoogle Scholar
  78. 78.
    Troughton RW, Frampton CM, Brunner-La Rocca H-P et al (2014) Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis. Eur Heart J 35:1559–1567. CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Koratala A, Kazory A (2017) Natriuretic peptides as biomarkers for congestive states: the cardiorenal divergence. Dis Markers 2017:1454986–1454989. CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Van Aelst LNL, Arrigo M, Placido R et al (2017) Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion. Eur J Heart Fail 20:738–747. CrossRefPubMedGoogle Scholar
  81. 81.
    Kociol RD, McNulty SE, Hernandez AF et al (2013) Markers of decongestion, dyspnea relief, and clinical outcomes among patients hospitalized with acute heart failure. Circ Heart Fail 6:240–245. CrossRefPubMedGoogle Scholar
  82. 82.
    Omar HR, Guglin M (2016) A single BNP measurement in acute heart failure does not reflect the degree of congestion. J Crit Care 33:262–265. CrossRefPubMedGoogle Scholar
  83. 83.
    Arrigo M, Truong QA, Onat D, Szymonifka J, Gayat E, Tolppanen H, Sadoune M, Demmer RT, Wong KY, Launay JM, Samuel JL, Cohen-Solal A, Januzzi JL Jr, Singh JP, Colombo PC, Mebazaa A (2017) Soluble CD146 is a novel marker of systemic congestion in heart failure patients: an experimental mechanistic and transcardiac clinical study. Clin Chem 63:386–393. CrossRefPubMedGoogle Scholar
  84. 84.
    Buckley LF, Carter DM, Matta L, Cheng JW, Stevens C, Belenkiy RM, Burpee LJ, Young MA, Weiffenbach CS, Smallwood JA, Stevenson LW, Desai AS (2016) Intravenous diuretic therapy for the management of heart failure and volume overload in a multidisciplinary outpatient unit. JACC Heart Fail 4:1–8. CrossRefPubMedGoogle Scholar
  85. 85.
    Ryder M, Murphy NF, McCaffrey D, O'Loughlin C, Ledwidge M, McDonald K (2008) Outpatient intravenous diuretic therapy; potential for marked reduction in hospitalisations for acute decompensated heart failure. Eur J Heart Fail 10:267–272. CrossRefPubMedGoogle Scholar
  86. 86.
    Shah N, Madanieh R, Alkan M, Dogar MU, Kosmas CE, Vittorio TJ (2017) A perspective on diuretic resistance in chronic congestive heart failure. Ther Adv Cardiovasc Dis 11:271–278. CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120:c179–c184. CrossRefPubMedGoogle Scholar
  88. 88.
    Damman K, Testani JM (2015) The kidney in heart failure: an update. Eur Heart J 36:1437–1444. CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Aldahl M, Jensen A-SC, Davidsen L, Eriksen MA, Møller Hansen S, Nielsen BJ, Krogager ML, Køber L, Torp-Pedersen C, Søgaard P (2017) Associations of serum potassium levels with mortality in chronic heart failure patients. Eur Heart J 38:2890–2896. CrossRefPubMedGoogle Scholar
  90. 90.
    Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cotter G, Dei Cas L (2012) Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail 5:54–62. CrossRefPubMedGoogle Scholar
  91. 91.
    Dupont M, Mullens W, Tang WHW (2011) Impact of systemic venous congestion in heart failure. Curr Heart Fail Rep 8:233–241. CrossRefPubMedGoogle Scholar
  92. 92.
    Regolisti G, Antoniotti R, Pastorini G, Fani F, Fiaccadori E (2016) Management of congestion and diuretic resistance in heart failure. Nephrol Point Care 2:pocj.5000200. CrossRefGoogle Scholar
  93. 93.
    ter Maaten JM, Valente MAE, Damman K, Hillege HL, Navis G, Voors AA (2015) Diuretic response in acute heart failure-pathophysiology, evaluation, and therapy. Nat Rev Cardiol 12:184–192. CrossRefPubMedGoogle Scholar
  94. 94.
    Hoorn EJ, Ellison DH (2017) Diuretic Resistance. Am J Kidney Dis 69:136–142. CrossRefPubMedGoogle Scholar
  95. 95.
    Bruyne LKMD (2003) Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad Med J 79:268–271. CrossRefPubMedPubMedCentralGoogle Scholar
  96. 96.
    Verbrugge FH, Grieten L, Mullens W (2014) New insights into combinational drug therapy to manage congestion in heart failure. Curr Heart Fail Rep 11:1–9. CrossRefPubMedGoogle Scholar
  97. 97.
    Gandhi S, Mosleh W, Myers RBH (2014) Hypertonic saline with furosemide for the treatment of acute congestive heart failure: a systematic review and meta-analysis. Int J Cardiol 173:139–145. CrossRefPubMedGoogle Scholar
  98. 98.
    Siddiqui WJ, Kohut AR, Hasni SF, Goldman JM, Silverman B, Kelepouris E, Eisen HJ, Aggarwal S (2017) Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis. Heart Fail Rev 22:685–698. CrossRefPubMedGoogle Scholar
  99. 99.
    Costanzo MR, Negoianu D, Jaski BE, Bart BA, Heywood JT, Anand IS, Smelser JM, Kaneshige AM, Chomsky DB, Adler ED, Haas GJ, Watts JA, Nabut JL, Schollmeyer MP, Fonarow GC (2016) Aquapheresis versus intravenous diuretics and hospitalizations for heart failure. JACC Heart Fail 4:95–105. CrossRefPubMedGoogle Scholar
  100. 100.
    Reed BN, Devabhakthuni S (2017) Diuretic resistance in acute decompensated heart failure: a challenging clinical conundrum. Crit Care Nurs Q 40:363–373. CrossRefPubMedGoogle Scholar
  101. 101.
    Gilotra NA, Princewill O, Marino B, Okwuosa IS, Chasler J, Almansa J, Cummings A, Rhodes P, Chambers J, Cuomo K, Russell SD (2018) Efficacy of intravenous furosemide versus a novel, pH-neutral furosemide formulation administered subcutaneously in outpatients with worsening heart failure. JACC Heart Fail 6:65–70. CrossRefPubMedGoogle Scholar
  102. 102.
    da Rosa PR, Rohde LE, Doebber M, Ribeiro ALP, Prado DP, Bertoldi EG, Figueiredo Neto JA, Kohler I, Beck-da-Silva L, Danzmann LC, Moura LZ, Rover M, Simões MV, Sant'Anna RT, Biolo A (2017) Rational and design of a randomized, double-blind, multicenter trial to evaluate the safety and tolerability of furosemide withdrawal in stable chronic outpatients with heart failure: the ReBIC-1 trial. Am Heart J 194:125–131. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
  2. 2.Centre of Cardiology and AngiologyVilnius University Hospital Santaros KlinikosVilniusLithuania
  3. 3.Department of CardiologyMaastricht University Medical CentreMaastrichtThe Netherlands

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