{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T20:49:57Z","timestamp":1789159797400,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Most episodes of acute heart failure (AHF) are characterized by increasing signs and symptoms of congestion, manifested by edema, pleura effusion and\/or ascites. Immediately and repeatedly administered intravenous (IV) loop diuretics currently represent the mainstay of initial therapy aiming to achieve adequate diuresis\/natriuresis and euvolemia. Despite these efforts, a significant proportion of patients have residual congestion at discharge, which is associated with a poor prognosis. Therefore, a standardized approach is needed. The door to diuretic time should not exceed 60 min. As a general rule, the starting IV dose is 20\u201340 mg furosemide equivalents in loop diuretic na\u00efve patients or double the preexisting oral home dose to be administered via IV. Monitoring responses within the following first hours are key issues. (1) After 2 h, spot urinary sodium should be \u226550\u201370 mmol\/L. (2) After 6 h, the urine output should be \u2265100\u2013150 mL\/hour. If these target measures are not reached, the guidelines currently recommend a doubling of the original dose to a maximum of 400\u2013600 mg furosemide per day and in patients with severely impaired kidney function up to 1000 mg per day. Continuous infusion of loop diuretics offers no benefit over intermittent boluses (DOSE trial). Emerging evidence by recent randomized trials (ADVOR, CLOROTIC) supports the concept of an early combination diuretic therapy, by adding either acetazolamide (500 mg IV once daily) or hydrochlorothiazide. Acetazolamide is particularly useful in the presence of a baseline bicarbonate level of \u226527 mmol\/L and remains effective in the presence of preexisting\/worsening renal dysfunction but should be used only in the first three days to prevent severe metabolic disturbances. Patients should not leave the hospital when they are still congested and\/or before optimized long-term guideline-directed medical therapy has been initiated. Special attention should be paid to AHF patients during the vulnerable post-discharge period, with an early follow-up visit focusing on up-titrate treatments of recommended doses within 2 weeks (STRONG-HF).<\/jats:p>","DOI":"10.3390\/jcm13020311","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T05:12:17Z","timestamp":1704431537000},"page":"311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Decongestion in Acute Heart Failure\u2014Time to Rethink and Standardize Current Clinical Practice?"],"prefix":"10.3390","volume":"13","author":[{"given":"Valentin","family":"Bilgeri","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5908-2923","authenticated-orcid":false,"given":"Philipp","family":"Spitaler","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Puelacher","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Messner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agne","family":"Adukauskaite","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4456-1822","authenticated-orcid":false,"given":"Fabian","family":"Barbieri","sequence":"additional","affiliation":[{"name":"Deutsches Herzzentrum der Charit\u00e9, Hindenburgdamm 30, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5711-244X","authenticated-orcid":false,"given":"Thomas","family":"Senoner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0421-2110","authenticated-orcid":false,"given":"Wolfgang","family":"Dichtl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","article-title":"A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010","volume":"175","author":"Gerber","year":"2015","journal-title":"JAMA Intern. 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