Pharmacotherapeutic principles of fluid management in heart failure.

Bharat Narasimhan, R Aravinthkumar, Ashish Correa, Wilbert S Aronow

Expert opinion on pharmacotherapy 2021 Apr

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Introduction: Heart failure is a major public health concern that is expected to increase over the decades to come. Despite significant advances, fluid overload and congestion remain a major therapeutic challenge. Vascular congestion and neurohormonal activation are intricately linked and the goal of therapy fundamentally aims to reduce both.Areas covered: The authors briefly review a number of core concepts that elucidate the link between fluid overload and neuro-hormonal activation. This is followed by a review of heart-kidney interactions and the impact of diuresis in this setting. Following an in-depth review of currently available pharmacological agents, the rationale and evidence behind their use, the authors end with a brief note on novel agents/approaches to aid volume management in HF.Expert opinion: A number of non-pharmacological advances in the management of volume overload in heart failure, though promising - are associated with a number of shortcomings. Pharmacological therapy remains the cornerstone of volume management. A number of novel approaches, utilizing existing therapies as well as the emergence of new agents over the past decade bode well for the vulnerable HF population.

Citation

Bharat Narasimhan, R Aravinthkumar, Ashish Correa, Wilbert S Aronow. Pharmacotherapeutic principles of fluid management in heart failure. Expert opinion on pharmacotherapy. 2021 Apr;22(5):595-610