Fast Five Quiz: Heart Failure With Reduced Ejection Fraction (HFrEF) Treatment Optimization

Alanna Morris, MD


September 09, 2021

According to guidelines from the European Society of Cardiology, diuretics are recommended to reduce the signs and symptoms of congestion in patients with HFrEF. Loop diuretics combined with thiazides may be used to treat resistant edema, but this combination should be used with care as it may increase the risk for adverse effects. As loop diuretics act on the thick ascending limb, which reabsorbs as much as 25% of the filtered sodium load, they generate a diuresis that is more intense but shorter in duration than that produced by thiazides.

ACC guidelines note that lower doses of loop diuretics may be necessary for initiation and/or optimal titration of an ARNI/ACEI/ARB to avoid hypotension and electrolyte/renal instability; in such cases, careful attention to potassium concentrations is necessary, as the kaliuretic effects of loop diuretics may no longer be present, and restriction of supplemental and/or dietary potassium may be required.

Learn more about the treatment of HFrEF.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.