Treatment
Table 23. Recommendations for Therapies in the
Hospitalized HF Patient
Recommendation
COR
LOE
HF patients hospitalized with fluid overload should be
treated with intravenous diuretics
I
B
HF patients receiving loop diuretic therapy should receive
an initial parenteral dose greater than or equal to their
chronic oral daily dose; then dose should be serially adjusted
I
B
HFrEF patients requiring HF hospitalization on GDMT
should continue GDMT except in cases of hemodynamic
instability or where contraindicated
I
B
Initiation of beta-blocker therapy at a low dose is
recommended after optimization of volume status and
discontinuation of intravenous agents
I
B
Thrombosis/thromboembolism prophylaxis is
recommended for patients hospitalized with HF
I
B
Serum electrolytes, urea nitrogen, and creatinine should be
measured during the titration of HF medications, including
diuretics
I
C
When diuresis is inadequate, it is reasonable to
a) give higher doses of intravenous loop diuretics
or
b) add a second diuretic (eg, thiazide)
IIa
B
Low-dose dopamine infusion may be considered with loop
diuretics to improve diuresis
IIb
B
Ultrafiltration may be considered for patients with obvious
volume overload
IIb
B
Ultrafiltration may be considered for patients with
refractory congestion
IIb
C
Intravenous nitroglycerin, nitroprusside, or nesiritide may
be considered an adjuvant to diuretic therapy for stable
patients with HF
IIb
B
In patients hospitalized with volume overload and severe
hyponatremia, vasopressin antagonists may be considered
IIb
B
42
B
