Patients admitted with acute decompensated heart failure and evidence of significant fluid overload require prompt, structured inpatient management. The central priorities are relieving congestion and restoring clinical stability before discharge.
The defining feature of this presentation is significant fluid overload — excess fluid accumulation that drives symptoms and elevates rehospitalisation risk. Systematic inpatient decongestion forms the foundation of care.
Intravenous loop diuretic therapy is the cornerstone of acute decongestion for admitted patients with fluid overload. Beyond diuresis, inpatient care also addresses optimisation of established guideline-directed medical therapy and prevention of venous thromboembolism. The complete regimen — specific agents, escalation criteria, and sequencing — is available in the full structured protocol.
Resolution of clinical evidence of congestion and fluid retention, with meaningful relief of symptoms, before discharge.
Patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to improve symptoms and reduce morbidity.
In patients with HFrEF requiring hospitalization, preexisting GDMT should be continued and optimized to improve outcomes, unless contraindicated.
In patients hospitalized with HF, prophylaxis for VTE is recommended to prevent venous thromboembolic disease.
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.
DOI: 10.1161/CIR.0000000000001063 View source ↗