Eur Rev Med Pharmacol Sci 2021; 25 (7): 2971-2980

DOI: 10.26355/eurrev_202104_25550

Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network meta-analysis

D. Orso, G. Tavazzi, F. Corradi, F. Mearelli, N. Federici, D. Peric, N. D’Andrea, G. Santori, F. Mojoli, F. Forfori, L. Vetrugno, T. Bove

Department of Medicine, University of Udine, Udine, Italy. luigi.vetrugno@asufc.sanita.fvg.it


OBJECTIVE: Up to 50% of patients hospitalized for acute heart failure (AHF) show resistance to diuretics. This condition contributes to a prolonged hospital length of stay and a higher risk of death. This review aimed to investigate whether a diuretic therapeutic approach more effective than furosemide alone exists for patients with diuretic-resistant AHF.

MATERIALS AND METHODS: We identified all randomized controlled trials (RCTs) evaluating diuretic therapy in patients with diuretic-resistant AHF. We searched Pubmed, BioMed Central, and Cochrane CENTRAL databases.

RESULTS: Six RCTs were identified, involving a total of 845 patients. The P-score ranges from 0.6663 for furosemide to 0.2294 for the tolvaptan-furosemide. We found no significant differences in efficacy for any drug comparison.

CONCLUSIONS: None of the diuretics considered in RCTs performed to date (tolvaptan, metolazone, hydrochlorothiazide, indapamide) appear to be more effective than furosemide therapy alone for the treatment of patients with diuretic-resistant AHF.

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D. Orso, G. Tavazzi, F. Corradi, F. Mearelli, N. Federici, D. Peric, N. D’Andrea, G. Santori, F. Mojoli, F. Forfori, L. Vetrugno, T. Bove
Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network meta-analysis

Eur Rev Med Pharmacol Sci
Year: 2021
Vol. 25 - N. 7
Pages: 2971-2980
DOI: 10.26355/eurrev_202104_25550