{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:35:50Z","timestamp":1784543750716,"version":"3.55.0"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<jats:p>Background: Heart failure is a common condition with considerable associated costs, morbidity, and mortality. Patients often present to hospital with dyspnea and edema. Inadequate inpatient decongestion is an important contributor to high readmission rates. There is little evidence concerning diuresis to guide clinicians in caring for patients with acute decompensated heart failure. Contemporary diuretic strategies have been defined by expert opinion and older landmark clinical trials.\nObjective: To present a narrative review of contemporary recommendations, along with their underlying evidence and pharmacologic rationale, for diuretic strategies in inpatients with acute decompensated heart failure.\nData Sources: PubMed, OVID, and Embase databases were searched from inception to December 22, 2022, with the following search terms: heart failure, acute heart failure, decompensated heart failure, furosemide, bumetanide, ethacrynic acid, hydrochlorothiazide, indapamide, metolazone, chlorthalidone, spironolactone, eplerenone, and acetazolamide.\nStudy Selection: Randomized controlled trials and systematic reviews involving at least 100 adult patients (&gt; 18 years) were included. Trials involving torsemide, chlorothiazide, and tolvaptan were excluded.\nData Synthesis: Early, aggressive administration of a loop diuretic has been associated with expedited symptom resolution, shorter length of stay, and possibly reduced mortality. Guidelines make recommendations about dose and frequency but do not recommend any particular loop diuretic over another; however, furosemide is most commonly used. Guidelines recommend that the initial furosemide dose (on admission) be 2\u20132.5 times the patient\u2019s home dose. A satisfactory diuretic response can be defined as spot urine sodium content greater than 50\u201370 mmol\/L at 2 hours; urine output greater than 100\u2013150 mL\/h in the first 6 hours or 3\u20135 L in 24 hours; or a change in weight of 0.5\u20131.5 kg in 24 hours. If congestion persists after the maximization of loop diuretic therapy over the first 24\u201348 hours, an adjunctive diuretic such as thiazide or acetazolamide should be added. If decongestion targets are not met, continuous infusion of furosemide may be considered.\nConclusions: Heart failure with congestion can be managed with careful administration of high-dose loop diuretics, supported by thiazides and acetazolamide when necessary. Clinical trials are underway to further evaluate this strategy.\nR\u00c9SUM\u00c9\nContexte\u00a0: L\u2019insuffisance cardiaque est une maladie courante entra\u00eenant des co\u00fbts, une morbidit\u00e9 et une mortalit\u00e9 consid\u00e9rables. Les patients se pr\u00e9sentent souvent \u00e0 l\u2019h\u00f4pital avec une dyspn\u00e9e et un \u0153d\u00e8me. Une d\u00e9congestion inad\u00e9quate des patients hospitalis\u00e9s contribue largement aux taux \u00e9lev\u00e9s de r\u00e9admission. Il existe peu de donn\u00e9es probantes concernant la diur\u00e8se pour guider les cliniciens dans la prise en charge des patients atteints d\u2019insuffisance cardiaque aigu\u00eb d\u00e9compens\u00e9e. Les strat\u00e9gies diur\u00e9tiques contemporaines ont \u00e9t\u00e9 d\u00e9finies par l\u2019opinion d\u2019experts et des essais cliniques de r\u00e9f\u00e9rence plus anciens.\nObjectif\u00a0: Pr\u00e9senter une revue narrative des recommandations contemporaines, ainsi que leurs donn\u00e9es probantes sous-jacentes et leur justification pharmacologique, pour les strat\u00e9gies diur\u00e9tiques chez les patients hospitalis\u00e9s souffrant d\u2019insuffisance cardiaque aigu\u00eb d\u00e9compens\u00e9e.\nSources des donn\u00e9es\u00a0: Les bases de donn\u00e9es PubMed, OVID et Embase ont \u00e9t\u00e9 consult\u00e9es depuis leur cr\u00e9ation jusqu\u2019au 22\u00a0d\u00e9cembre\u00a02022, avec les termes de recherche suivants\u00a0: insuffisance cardiaque, insuffisance cardiaque aigu\u00eb, insuffisance cardiaque d\u00e9compens\u00e9e, furos\u00e9mide, bum\u00e9tanide, acide \u00e9thacrynique, hydrochlorothiazide, indapamide, m\u00e9tolazone, chlorthalidone, spironolactone, \u00e9pl\u00e9r\u00e9none et ac\u00e9tazolamide.\nChoix de l\u2019\u00e9tude\u00a0: Les essais contr\u00f4l\u00e9s randomis\u00e9s et les revues syst\u00e9matiques portant sur au moins 100 patients adultes (plus de 18 ans) ont \u00e9t\u00e9 inclus. Les essais impliquant le tors\u00e9mide, le chlorothiazide et le tolvaptan ont \u00e9t\u00e9 exclus.\nSynth\u00e8se des donn\u00e9es\u00a0: L\u2019administration pr\u00e9coce et agressive d\u2019un diur\u00e9tique de l\u2019anse a \u00e9t\u00e9 associ\u00e9e \u00e0 une r\u00e9solution acc\u00e9l\u00e9r\u00e9e des sympt\u00f4mes, \u00e0 une dur\u00e9e de s\u00e9jour plus courte et \u00e9ventuellement \u00e0 une mortalit\u00e9 r\u00e9duite. Les lignes directrices font des recommandations sur la dose et la fr\u00e9quence, mais ne recommandent pas un diur\u00e9tique de l\u2019anse particulier plut\u00f4t qu\u2019un autre; cependant, le furos\u00e9mide est le plus couramment utilis\u00e9. Les lignes directrices recommandent que la dose initiale de furos\u00e9mide \u00e0 l\u2019admission soit de 2 \u00e0 2,5 fois la dose \u00e0 domicile du patient. Une r\u00e9ponse diur\u00e9tique satisfaisante peut \u00eatre d\u00e9finie comme une teneur ponctuelle en sodium dans l\u2019urine sup\u00e9rieure \u00e0 50 \u00e0 70\u00a0mmol\/L apr\u00e8s 2 heures; d\u00e9bit urinaire sup\u00e9rieur \u00e0 100 \u00e0 150\u00a0mL\/h au cours des 6 premi\u00e8res heures ou \u00e0 3 \u00e0 5 L en 24\u00a0heures; ou un changement de poids de 0,5 \u00e0 1,5\u00a0kg en 24 heures. Si la congestion persiste apr\u00e8s la maximisation du traitement par diur\u00e9tique de l\u2019anse au cours des premi\u00e8res 24 \u00e0 48 heures, un diur\u00e9tique d\u2019appoint tel que le thiazidique ou l\u2019ac\u00e9tazolamide doivent \u00eatre ajout\u00e9s. Si les objectifs de d\u00e9congestion ne sont pas atteints, une perfusion continue de furos\u00e9mide peut \u00eatre envisag\u00e9e.\nConclusions\u00a0: L\u2019insuffisance cardiaque accompagn\u00e9e de congestion peut \u00eatre g\u00e9r\u00e9e par l\u2019administration prudente de diur\u00e9tiques de l\u2019anse \u00e0 haute dose, appuy\u00e9s par des thiazidiques et de l\u2019ac\u00e9tazolamide si n\u00e9cessaire. Des essais cliniques sont en cours pour \u00e9valuer davantage cette strat\u00e9gie.<\/jats:p>","DOI":"10.4212\/cjhp.3323","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T17:42:26Z","timestamp":1704476546000},"source":"Crossref","is-referenced-by-count":11,"title":["Diuretic Strategies in Acute Decompensated  Heart Failure: A Narrative Review"],"prefix":"10.4212","volume":"77","author":[{"given":"Ben","family":"Wilson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duane","family":"Bates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2732","published-online":{"date-parts":[[2024,1,10]]},"container-title":["Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3323\/5114","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3323\/5142","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/download\/3323\/5114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T18:11:18Z","timestamp":1705083078000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/3323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,10]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,10]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.3323","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2024,1,10]]},"article-number":"e3323"}}