Three diuretic escalation approaches were associated with similar weight loss at 48 hours.
Diuretic resistance creates challenges in the management of acute decompensated heart failure (HF). Current guidelines, based only on expert consensus, recommend supplementing loop diuretics with thiazides. This manufacturer-supported, single-center, randomized, double-blind trial (NCT02606253) examined three strategies in 60 individuals (mean age, 62; men, 71%; preserved systolic function, 23%) hospitalized for HF with volume overload and diuretic resistance, defined as <2 L total urine output for 12 hours pre-enrollment despite ≥240 mg furosemide equivalent daily (mean prerandomization furosemide-equivalent dose, 612 mg/day).
Among the exclusions were severe renal dysfunction (estimated glomerular filtration rate, <15 mL/minute/1.73 m2) an…
Reviewing Author
DisclosuresConsultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research
Grant/Research SupportNational Heart, Lung, and Blood Institute
Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)
Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)
DisclosuresConsultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research
Grant/Research SupportNational Heart, Lung, and Blood Institute
Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)
Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)