Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function.
Cite this article
89
Downloads
12
Citations
277
Views
Announcements
Open Access
Review
Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review
Girish Singhania1,*, Abutaleb A. Ejaz2, Peter A. McCullough3,4,5,6, Aaron Y. Kluger3,7, Saravanan Balamuthusamy8,9, Bhagwan Dass10, Namrata Singhania11, Adhish Agarwal12
Show Less
1
Department of Hospital Medicine, CHI St. Vincent Infirmary, Little Rock, AR, 72205, USA
2
Division of Nephrology, University of Florida, Gainesville, FL, 32610, USA
3
Baylor Heart and Vascular Institute, Dallas, TX, 75226, USA
4
Texas A&M College of Medicine Health Science Center, Dallas, TX, 75246, USA
5
Baylor University Medical Center, Dallas, TX,75246, USA
6
Baylor Heart and Vascular Hospital, Dallas, TX,75226, USA
7
Baylor Scott and White Research Institute, Dallas, TX,75204, USA
8
Texas Christian University/University of North Texas School of Medicine, Fort Worth, TX, 76129, USA
9
Tarrant Nephrology, Fort Worth, Texas, 76132, USA
10
Department of Hospital Medicine, University of Florida, Gainesville, FL, 32610, USA
11
Department of Hospital Medicine, Mount Carmel East Hospital, Columbus, OH, 43213, USA
12
Division of Nephrology, University of Utah, Salt Lake City, UT, 84112, USA
*Correspondence: mamc.girish@gmail.com (Girish Singhania)
Rev. Cardiovasc. Med. 2019, 20(3), 111–120;
https://doi.org/10.31083/j.rcm.2019.03.562
Submitted: 1 September 2019 | Accepted: 23 September 2019 | Published: 30 September 2019
Copyright: © 2019 Singhania et al. Published by IMR press.
This is an open access article under the CC BY-NC 4.0 license https://creativecommons.org/licenses/by/4.0/.
Abstract
Keywords
Acute heart failure
cardiorenal syndrome
cardiovascular outcomes
medication continuation
medication discontinuation
Figures
Figure 1