Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

Highlights There is a bidirectional relationship between HF and liver disease. NAFLD may drive some HFpEF phenotypes. This review proposes 3 HFpEF phenotypes: obstructive HFpEF, metabolic HFpEF/NAFLD, and advanced liver disease/cirrhosis HFpEF. Additional studies are required to explore the pathophysiology and hemodynamic parameters of these phenotypes and investigate potential treatments.

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Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy. Historically, therapy has primarily focused on water restriction, decongestion with loop diuretics in case of volume overload (dilutional hyponatraemia) and sodium repletion in case of depletion. In this review, we summarise the potential benefits of established and emerging HF therapies on sodium homeostasis, with a focus on dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors and hypertonic saline, and propose a potential therapeutic approach for hyponatraemia in HF.

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