Muddying the Water: Reduced vs. Preserved Ejection Fraction in Trials of Acute Decompensated Heart Failure

Evidence from randomized controlled trials has demonstrated that the cornerstone pharmacologic therapies used in the management of chronic heart failure with reduced ejection fraction (HFrEF) do not confer the same benefits in patients with preserved ejection fraction (HFpEF). So why do we enroll both subgroups in trials of acute decompensated heart failure (ADHF)? In this entry, we’ll explore differences in pathophysiology between HFrEF and HFpEF and how they may result in variable responses to pharmacologic therapies commonly used in ADHF, particularly diuretics and vasodilators.

Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 2)

In Part 1 of this two-part series, we highlighted some of the limitations of the Diuretic Optimization Strategies Evaluation (DOSE) trial as well as populations in whom continuous infusions of loop diuretics may have advantages over intermittent boluses. In Part 2, we will review some of the disadvantages associated with continuous infusions, as well as pearls for optimally managing them in patients with acute decompensated heart failure.

Which Patients with Heart Failure Should Get Loop Diuretics as a Continuous Infusion? (Part 1)

In the Diuretic Optimization Strategies Evaluation (DOSE) trial, intravenous boluses of loop diuretics were shown to as efficacious and safe as continuous infusions in patients with acute decompensated heart failure. However, the heterogeneity of the population enrolled in DOSE makes it difficult to identify patient populations who might actually benefit from one strategy over another. In Part 1 of this two-part series, we’ll explore several potential populations in whom continuous infusions may be beneficial over intermittent boluses.

Which Thiazide-Type Diuretic Should be First-Line in Patients with Hypertension?

The Eighth National Joint Committee recommends a thiazide-type diuretic as one of the first line treatment options for patients with hypertension. However, there is substantial evidence to support the use of a thiazide-like diuretic (e.g., chlorthalidone) over a thiazide diuretic (e.g., hydrochlorothiazide or HCTZ). In this piece, we review the data on why thiazide-like agents should be preferred in this setting.