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9.2. Maintenance or Optimization of GDMT During
Hospitalization
COR LOE
Recommendations
1 B-NR 1. In patients with HFrEF requiring hospitalization, preexisting
GDMT should be continued and optimized to improve
outcomes, unless contraindicated.
1 B-NR 2. In patients experiencing mild decrease of renal function
or asymptomatic reduction of blood pressure during HF
hospitalization, diuresis and other GDMT should not
routinely be discontinued.
1 B-NR 3. In patients with HFrEF, GDMT should be initiated during
hospitalization after clinical stability is achieved.
1 B-NR 4. In patients with HFrEF, if discontinuation of GDMT is
necessary during hospitalization, it should be reinitiated and
further optimized as soon as possible.
9.3. Diuretics in Hospitalized Patients: Decongestion
Strategy
COR LOE
Recommendations
1 B-NR 1. Patients with HF admitted with evidence of significant fluid
overload should be promptly treated with intravenous loop
diuretics to improve symptoms and reduce morbidity.
1 B-NR 2. For patients hospitalized with HF, therapy with diuretics and
other guideline-directed medications should be titrated with
a goal to resolve clinical evidence of congestion to reduce
symptoms and rehospitalizations.
1 B-NR 3. For patients requiring diuretic treatment during
hospitalization for HF, the discharge regimen should include a
plan for adjustment of diuretics to decrease rehospitalizations.
2a B-NR 4. In patients hospitalized with HF when diuresis is inadequate
to relieve symptoms and signs of congestion, it is reasonable to
intensify the diuretic regimen using either:
a. higher doses of intravenous loop diuretics; or
b. addition of a second diuretic.
