Intravenous Diuretic Therapy for the Management of Heart Failure and Volume Overload in a Multidisciplinary Outpatient Unit

Abstract

Short courses of IV diuretics for volume management in patients with HF were safe and associated with significant urine output and weight loss across a wide range of maintenance diuretic doses and EF. This strategy may provide an alternative to hospitalization for the management of selected HF patients.

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

“…Afterwards, determination of urinary spot sodium content allows the clinician to interpret diuretic response, thereby generating the opportunity to intervene if sodium content is low. In the face of congestion with volume overload, a spot urine sodium content of < 50–70 mEq/L after 2 h, and/or an hourly urine output < 100–150 mL during the first 6 h, generally identifies a patient with an insufficient diuretic response . In patients who produce sufficient urinary volumes following a first intravenous loop diuretic administration, urinary sodium is almost universally high.…”

Multidisciplinary team approach to heart failure management

“…The HF MDT will be a key to providing the intensive support that such patients will need to be managed safely. Limited early data suggest that intravenous diuretic therapy can be safely and effectively delivered by an MDT to outpatients 31. Changing systems of care for patients with acute HF will undoubtedly represent a significant organisational challenge to many.…”

Dilemmas in the Dosing of Heart Failure Drugs: Titrating Diuretics in Chronic Heart Failure

“…Preliminary reported experiences so far have demonstrated this as a safe and effective way to decongest hemodynamically stable patients and potentially reduce hospitalisations for heart failure and overall healthcare costs. [28][29][30] These outpatient heart failure units may therefore be useful to address those stable patients who appear to have diuretic resistance not surmountable by oral doses and just need some decongestion in order to respond to oral doses again.…”