Breakout Session Diuretics in Heart Failure

Dino Recchia, MD, FACC, FHFSA

Nancy Harris, MSN, FNP, CHFN

Sheila Falk, BSN, RN

Lisa McPherson, BSN, RN

Mary McManemy BSN, RN

Maureen Guertin, BSN, RN

Munson Heart Failure Team

Multidisciplinary

HF Cardiologist

HF Nurse Practitioner

Advanced Practice HF Nurses

Clinic Coordinator

All members function at the top

of their credential.

Reduced Hospitalizations

2.0

1

2.6

0.8

BEFORE HF PROGRAM REDUCED EF

AFTER HF PROGRAM REDUCED EF

BEFORE HF PROGRAM PRESERVED EF

AFTER HF PROGRAM PRESERVED EF

Average Hospitalizations per Pt Annually by HF Phenotype

Question

What matters most when decongesting a patient with heart failure?

A. Na excretion

B. Water excretion

C. Both

D. Neither

E. Location of the nearest bathroom

HFSA 22nd Annual Scientific Meeting

Voiding the Gap: Optimizing Diuretic Strategies with Something Old,

Something New, Something Borrowed, and Something Blue

Page 8 of 25

HFSA 22nd Annual Scientific Meeting

Voiding the Gap: Optimizing Diuretic Strategies with Something Old,

Something New, Something Borrowed, and Something Blue

Page 8 of 25

Na Excretion Predicts Survival

Question

In which part of the nephron is the majority of the filtered Na reabsorbed?

A. Proximal tubule

B. Loop of Henle

C. Distal tubule

D. What is a nephron

70%

Thiazides Aldosterone antagonists

Metolazone

Loop diuretics

Acetazolamide SGLT2 Inhibitors

Na Reabsorption Along the Nephron

25%

5%

Diuretic Resistance in HF

Diminished maximal response Higher dose to achieve same effect

Plasma Diuretic Concentration P

lasm

a D

iure

tic

Co

nce

ntr

atio

n

Higher natriuretic threshold in HF

Braking Phenomenon & Post –Diuretic Na Retention

Diuretic Efficiency Lessens with Time

Edema Effusion Ascites

Plasma Refill Rate

Extracellular

Volume

10-20 L Excess

Blood Vessels

5-6 L

Plasma Refill Rate 100-300 ml/hr

Intravascular

Volume

Plasma Volume Loss 100-300 ml/hr

100-300 ml/hr Diuresis

PRR declines as euvolemia approaches

Loop Diuretics

Furosemide Torsemide Bumetanide

Relative potency oral 80 20 1

Relative potency IV 40 20 1

Bioavailability Avg 50% 80-100% 80-100%

Affected by food Yes No Yes

Half life

Normal 1-2h 3-4h 1h

Heart failure 3h 6h 1-2h

Renal dysfunction 3h 4-5h 1-2h

Diuretic Resistance

Questions