Abstract
The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim was to analyze the different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments. Single-centre study of 1,559 patients admitted for decompensated HF between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilisation and discharge from the hospital: 1) Loop diuretic. 2)Loop diuretic+distal tubule (antialdosterone±thiazides). 3) Loop diuretic+distal+proximal tubule (acetazolamide±SGLT2 inhibitor). 4) Loop diuretic+distal tubule+collecting duct (tolvaptan). 5) Loop diuretic+distal+proximal+collecting duct. Based on these diuretic combinations, profiles with clinical, analytical and echocardiographic differences were established. There were more previous hospitalizations in groups 4 and 5 (p=0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p=0.01 and p=0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p=0.0001) and left ventricular (p=0.003) function. Diuretic therapy-defined groups then proved to also differ in clinical characteristics. The diuretic treatment used identifies 5 clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission.
Published Version
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