Diuretics play a central role in the management of patients with heart failure. In fact, they are used to achieve and maintain euvolaemia through adequate fluid balance. The effects, clinical benefits and implications of diuretic therapy are well established. However, little is known about the inconveniences posed to patients by diuretics and the adaptations adopted by them to counteract these challenges.

We conducted a study to investigate the patient impact of diuretic therapy.

A comprehensive questionnaire was formulated and distributed to patients with established heart failure (with reduced and preserved ejection fraction) attending a specialized heart failure service. Questionnaires were given to patients once they had been established on heart failure disease-modifying therapy and diuretic therapy for at least 3 months and had received self-care education including information on medication and adherence to drug regimens. Patients were established either on oral furosemide or bumetanide with doses ranging from 20 to 80 mg daily and 0.5 to 6 mg daily, respectively. The questionnaire encompassed information on inconvenience from the use of diuretics, what those manifestations were (if any) and what the patients did to overcome the inconvenience (if something was done). The patients also commented on whether they felt that the benefits were worth the inconvenience of the diuretics.

A sample of 150 patients was analysed; 53% of the patients (n = 79) reported experiencing inconvenience secondary to the use of diuretics. The most common ones were difficulty leaving the house (30%, n = 48), difficulty sleeping at night-time (17%, n = 32), feeling anxious (15%, n = 29), difficulty meeting friends and family (14%, n = 22), difficulty pursing their hobbies (13%, n = 19) and difficulty in their sexual life (11%, n = 16). Of the patients impacted by the use of diuretics, 87% (n = 69) acted in response to the inconveniences opting for staying at home (25%, n = 46), reducing their level of activities (25%, n = 46), altering the time of diuretics (19%, n = 35), fluid restriction (19%, n = 35), avoiding using diuretics (9%, n = 18) and contacting doctors or heart failure nurses (3%, n = 6). The remaining 10 patients who experienced inconvenience (13%) reported not seeking medical attention or applying any changes to their routine or therapy. Lastly, 58 patients (73%) who experienced inconveniences stated that the benefits resulting from the use of diuretics were worth their side effects (Table 1).

In this study on the inconvenience posed to patients by diuretic therapy, the data demonstrate that more than half of patients experience inconvenience. These difficulties and subsequent patient response present clinical and social risk to the patients with reduced activity and reduction/cessation of diuretic without medical consultation.

We believe that heightened awareness of these challenges among healthcare personnel posed by diuretics to patients is important in order to best advise on how to combat these difficulties. Further studies on whether specific types of diuretics may cause greater inconvenience for the patients would be warranted as well as follow-up to assess the incidence of iatrogenic decompensations in this cohort.

利尿剂在心力衰竭患者的管理中起着核心作用。事实上，它们用于通过充分的体液平衡来实现和维持正常血容量。利尿剂治疗的效果、临床益处和意义已得到充分证实。然而，人们对利尿剂给患者带来的不便以及他们为应对这些挑战而采取的调整知之甚少。

我们进行了一项研究，以调查利尿剂治疗对患者的影响。

制定了一份全面的问卷，并分发给接受专业心力衰竭服务的确诊心力衰竭患者 （射血分数降低和保留）。一旦患者接受心力衰竭、疾病缓解治疗和利尿剂治疗至少 3 个月，并接受了自我护理教育，包括药物治疗信息和药物治疗方案的依从性，则向患者发放问卷。患者口服呋塞米或布美他尼，剂量分别为每天 20 至 80 毫克和每天 0.5 至 6 毫克。问卷包括有关使用利尿剂带来的不便的信息、这些表现是什么（如果有）以及患者如何克服不便（如果做了什么）。患者还评论了他们是否觉得利尿剂的好处值得。

分析了 150 名患者的样本;53% 的患者 （n = 79） 报告因使用利尿剂而感到不便。最常见的是出门困难 （30%，n = 48）、夜间睡眠困难 （17%，n = 32）、感到焦虑 （15%，n = 29）、与朋友和家人见面困难 （14%，n = 22）、追求爱好困难 （13%，n = 19） 和性生活困难 （11%，n = 16）。在受使用利尿剂影响的患者中，87% （n = 69） 因不便而采取行动，选择呆在家里 （25%，n = 46），减少他们的活动水平 （25%，n = 46），改变利尿剂的时间 （19%，n = 35），限制液体 （19%，n = 35），避免使用利尿剂 （9%，n = 18） 和联系医生或心力衰竭护士 （3%， n = 6）。其余 10 名感到不便的患者 （13%） 报告没有寻求医疗护理或对他们的日常生活或治疗进行任何改变。最后，58 名经历过不便的患者 （73%） 表示，使用利尿剂带来的好处是值得的（表1）。

在这项关于利尿剂治疗给患者带来的不便的研究中，数据表明，超过一半的患者感到不便。这些困难和随后的患者反应给活动减少和减少/停止利尿剂的患者带来临床和社会风险，而无需就医。

我们相信，提高医护人员对利尿剂给患者带来的这些挑战的认识对于如何应对这些困难提供最佳建议非常重要。有必要进一步研究特定类型的利尿剂是否会给患者带来更大的不便，并进行随访以评估该队列中医源性失代偿的发生率。