An Update on the Role of Digoxin in Older Adults with Chronic Heart Failure



Geriatrics and Aging. 2008;11(1):37-41. 

In This Article

Treatment of Heart Failure: Diuretics

Diuretics are commonly used in the treatment of HF, regardless of ejection fraction, and most persons with HF require diuretics to achieve and maintain euvolemia. However, the use of diuretics for HF is the only class I recommendation for drug therapy that is based on level C evidence (generally due to a lack of data from randomized clinical trials or nonrandomized studies).[2,6] There is growing evidence that the use of diuretics may activate neurohormones and be associated with a poor prognosis.[9,10,11] Therefore, once euvolemia is achieved, the dose of diuretic should be reduced to the lowest dose that will maintain euvolemia. Torsemide may be superior to furosemide as it is less likely to cause neurohormonal activation and hypokalemia.[12,13] Low serum potassium is common in HF and is worsened by the use of diuretics. Serum potassium <4 mEq/L may be associated with increased mortality in HF.[14] Serum potassium should be kept at approximately 4.5 mEq/L for persons with chronic HF.[15] While potassium supplements may be used to correct hypokalemia, aldosterone antagonists may be superior to potassium supplements in maintaining normokalemia.[16]


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