Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?,European Journal of Heart Failure

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Decongestion in acute heart failure: Is it time to change diuretic-centred paradigm?
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-08-21 , DOI: 10.1002/ejhf.3423
Jan Biegus ₁ , Gad Cotter _{2,

3} , Marco Metra ₄ , Piotr Ponikowski ₁

Affiliation

Congestion is a common cause of clinical deterioration and the most common clinical presentation at admission in acute heart failure (HF). Therefore, finding effective and sustainable ways to alleviate congestion has become a crucial goal for treating HF patients. Congestion is a result of complex underlying pathophysiology; therefore, it is not a direct cause of the disease but its consequence. Any therapy that directly promotes sodium/water removal only, thus targeting only clinical symptoms, neither modifies the natural course of the disease nor improves prognosis. This review aims to provide a comprehensive evaluation of the current decongestive therapies and propose a new (not diuretic-centred) paradigm of long-term congestion management in HF that attempts to correct the underlying pathophysiology, thus improving congestion, preventing its development, and favourably altering the natural course of the disease rather than merely treating its symptoms.

中文翻译：

急性心力衰竭的去充血：是时候改变以利尿剂为中心的范式了吗？

充血是临床恶化的常见原因，也是急性心力衰竭（HF）入院时最常见的临床表现。因此，寻找有效且可持续的方法来缓解充血已成为治疗 HF 患者的关键目标。充血是复杂潜在病理生理学的结果;因此，它不是疾病的直接原因，而是其后果。任何直接促进钠/水去除的疗法，因此仅针对临床症状，既不会改变疾病的自然病程，也不会改善预后。本综述旨在对当前的减充血疗法进行全面评估，并提出一种新的（不以利尿剂为中心）HF 长期充血管理范式，试图纠正潜在的病理生理学，从而改善充血，防止其发展，并有利地改变疾病的自然进程，而不仅仅是治疗其症状。

更新日期：2024-08-21

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