Saturday, November 07, 2015

Managing volume overload in decompensated heart failure

Key points from a review in mayo Clinic Proceedings:

Although larger trials are needed, small studies suggest the superiority of torsemide compared with other available loop diuretics.

Routine continuous intravenous infusion of loop diuretics offers no added benefits in removing fluid compared with intravenous bolus administration.

Nesiritide and dopamine have limited, if any, roles in managing volume overload in patients with acute decompensated heart failure.

Vasopressin antagonists may help decrease volume overload in patients with acute decompensated heart failure and hyponatremia.

Ultrafiltration can remove fluid in diuretic-refractory patients, but clinical studies show no benefits compared with more intensive, optimal diuretic therapy regimens.

Small observational and clinical studies have not shown a benefit in restricting sodium intake in patients with heart failure; further studies are required before a definitive conclusion can be reached.

Implantable hemodynamic monitoring devices have a promising future, and their role in managing heart failure will continue to evolve in the next 5 to 10 years.

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