Because signs of congestion are associated with adverse outcomes in patients with acute heart failure (AHF), attempts were made to decongest patients as much as possible with diuretic agents (loop diuretic agents, thiazides, acetazolamide) or mechanical devices. Those interventions improved signs of congestion but failed to meaningfully improve patients’ symptoms, improve quality of life, or reduce early readmissions or deaths. Recent studies have shown that implementation of guideline-directed medical therapies after an AHF admission led to both more decongestion and improved symptoms, quality of life, and outcomes. Therefore, for most patients with AHF whose symptoms and congestion can be controlled with loop diuretic agents, the main focus should be rapid guideline-directed medical therapy uptitration. Enhanced decongestion, ie, adding a second-line diuretic agent to a loop diuretic agent, should be reserved for those patients who do not respond to loop diuretic agents.

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急性心力衰竭患者的强化减充血治疗：JACC 本周评论主题

由于充血迹象与急性心力衰竭 (AHF) 患者的不良后果相关，因此尝试使用利尿剂（袢利尿剂、噻嗪类、乙酰唑胺）或机械装置尽可能地减轻患者充血。这些干预措施改善了充血症状，但未能有效改善患者的症状、提高生活质量或减少早期再入院或死亡。最近的研究表明，在 AHF 入院后实施指南指导的药物治疗可以减轻充血并改善症状、生活质量和结果。因此，对于大多数症状和充血可以用袢利尿剂控制的 AHF 患者来说，主要重点应该是快速提高指南指导的药物治疗。加强减充血，即在袢利尿剂中添加二线利尿剂，应保留给那些对袢利尿剂没有反应的患者。