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Table 25. 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 aer optimization of volume status and
discontinuation of intravenous agents
I B
rombosis/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
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
Treatment
