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Purpose of Review <p>Acute heart failure (AHF) remains a leading cause of hospitalization worldwide, associated&#xa0;with significant morbidity and mortality despite advances in chronic heart failure&#xa0;management. Rapid identification and treatment of the underlying cause, alongside prompt&#xa0;and effective decongestion, remain the principal therapeutic goals.</p> Recent Findings <p>Intravenous loop diuretics constitute the cornerstone of acute management. Their clinical&#xa0;efficacy is influenced by the delivery route, the administered dose, and the timing at which&#xa0;diuretics are initiated. Nevertheless, challenges such as incomplete decongestion, diuretic&#xa0;resistance, and renal or electrolyte disturbances frequently complicate treatment. Recent&#xa0;evidence highlights several adjunctive strategies to optimize decongestion and improve&#xa0;outcomes in AHF. These include sequential nephron blockade with acetazolamide, thiazide&#xa0;and thiazide-like diuretics, as well as other therapeutic options including mineralocorticoid&#xa0;receptor antagonists, sodium–glucose co-transporter 2 inhibitors and the vasopressin V2 receptor antagonist – tolvaptan. Growing interest has also been directed toward natriuresis-guided diuretic protocols and device-based fluid removal approaches.</p> Summary <p>This review synthesizes current evidence regarding these interventions, highlighting their&#xa0;potential to enhance decongestion, overcome diuretic resistance, and ultimately improve&#xa0;clinical outcomes in patients with AHF.</p>

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Decongestion Strategies in Acute Heart Failure

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Agata Kundera-Mądro,
  • Łukasz Zandecki,
  • Łukasz Turek,
  • Kinga Kasperek,
  • Marianna Janion

摘要

Purpose of Review

Acute heart failure (AHF) remains a leading cause of hospitalization worldwide, associated with significant morbidity and mortality despite advances in chronic heart failure management. Rapid identification and treatment of the underlying cause, alongside prompt and effective decongestion, remain the principal therapeutic goals.

Recent Findings

Intravenous loop diuretics constitute the cornerstone of acute management. Their clinical efficacy is influenced by the delivery route, the administered dose, and the timing at which diuretics are initiated. Nevertheless, challenges such as incomplete decongestion, diuretic resistance, and renal or electrolyte disturbances frequently complicate treatment. Recent evidence highlights several adjunctive strategies to optimize decongestion and improve outcomes in AHF. These include sequential nephron blockade with acetazolamide, thiazide and thiazide-like diuretics, as well as other therapeutic options including mineralocorticoid receptor antagonists, sodium–glucose co-transporter 2 inhibitors and the vasopressin V2 receptor antagonist – tolvaptan. Growing interest has also been directed toward natriuresis-guided diuretic protocols and device-based fluid removal approaches.

Summary

This review synthesizes current evidence regarding these interventions, highlighting their potential to enhance decongestion, overcome diuretic resistance, and ultimately improve clinical outcomes in patients with AHF.