Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review

doi:10.31083/j.rcm.2019.03.562

Reviews in Cardiovascular Medicine

2019, Vol. 20

Issue (3): 111-120 DOI: 10.31083/j.rcm.2019.03.562

Special Issue: Cardiovascular disorders in chronic kidney disease

Review

| Next articles

Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review

Girish Singhania^1,^*(

), Abutaleb A. Ejaz², Peter A. McCullough^3,^4,^5,⁶, Aaron Y. Kluger^3,⁷, Saravanan Balamuthusamy^8,⁹, Bhagwan Dass¹⁰, Namrata Singhania¹¹, Adhish Agarwal¹²

¹ Department of Hospital Medicine, CHI St. Vincent Infirmary, Little Rock, AR, 72205, USA
² Division of Nephrology, University of Florida, Gainesville, FL, 32610, USA
³ Baylor Heart and Vascular Institute, Dallas, TX, 75226, USA
⁴ Texas A&M College of Medicine Health Science Center, Dallas, TX, 75246, USA
⁵ Baylor University Medical Center, Dallas, TX,75246, USA
⁶ Baylor Heart and Vascular Hospital, Dallas, TX,75226, USA
⁷ Baylor Scott and White Research Institute, Dallas, TX,75204, USA
⁸ Texas Christian University/University of North Texas School of Medicine, Fort Worth, TX, 76129, USA
⁹ Tarrant Nephrology, Fort Worth, Texas, 76132, USA
¹⁰ Department of Hospital Medicine, University of Florida, Gainesville, FL, 32610, USA
¹¹ Department of Hospital Medicine, Mount Carmel East Hospital, Columbus, OH, 43213, USA
¹² Division of Nephrology, University of Utah, Salt Lake City, UT, 84112, USA

Download: PDF(991KB) ( 1568 ) Full text ( 134 )
Export: BibTeX | EndNote (RIS)

Abstract:

Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function.

Key words: Acute heart failure cardiorenal syndrome cardiovascular outcomes medication continuation medication discontinuation

Submitted: 01 September 2019 Accepted: 23 September 2019 Published: 30 September 2019

^*Corresponding Author(s): Girish Singhania E-mail: mamc.girish@gmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Girish Singhania
	Abutaleb A. Ejaz
	Peter A. McCullough
	Aaron Y. Kluger
	Saravanan Balamuthusamy
	Bhagwan Dass
	Namrata Singhania
	Adhish Agarwal

Cite this article:

Girish Singhania, Abutaleb A. Ejaz, Peter A. McCullough, Aaron Y. Kluger, Saravanan Balamuthusamy, Bhagwan Dass, Namrata Singhania, Adhish Agarwal. Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review. Reviews in Cardiovascular Medicine, 2019, 20(3): 111-120.

URL:

https://rcm.imrpress.com/EN/10.31083/j.rcm.2019.03.562 OR https://rcm.imrpress.com/EN/Y2019/V20/I3/111

Figure 1. Physiological benefits of renin-angiotensin-aldosterone system inhibitors and neprilysin inhibitors in acute heart failure. RAASi, renin-angiotensin-aldosterone system inhibitors; AT1, angiotensin II receptor type 1; ADH, antidiuretic hormone; NEPi, neprilysin inhibitors, ANP, atrial natriuretic peptide; BNP, b-type natriuretic peptide or brain natriuretic peptide; CNP, c-type natriuretic peptide; PCWP, pulmonary capillary wedge pressure.

Table 1 Studies showing the effects of angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers and/or diuretics in patients with acute heart failure.

First Author/ Year/ Reference	Study Design	N	Intervention	Outcomes				Major findings/comments
First Author/ Year/ Reference	Study Design	N	Intervention	Renal outcomes	Hypotension	Hyperkalemia (HK)	Mortality/CV outcomes	Major findings/comments
Iglesias et al., 2019	Retrospective Age ≥ 65 years patients	2,361	Role of ACEi/ARB on mortality in CRS1	CRS1 occurred in 637 patients	NA	NA	In-hospital mortality decreased significantly in patients receiving ACEi/ARB (6.8% vs 32.8%, OR 0.34, 95% CI 0.25-0.49). Development of CRS1 was significantly associated with increased in-hospital mortality (6.0% vs 3.9%, OR 1.54, 95% CI 1.03-2.3)	Two strongest independent predictors of in-hospital mortality were CRS1 development (OR 7.8, 95% CI 3.9-15.5) and lack of ACEI/ARB usage (OR 0.49, 95% CI 0.25-0.93)
Kane et al., 2017	Retrospective chart review	174	30 patients reduced/Discontinued (r/d) ACEi/ARB	13 patients had WRF	4 patients had SBP less than 100	3 patients had HK	ACEi/ARB dose r/d group had a significantly greater median LOS (5.5 vs 3.0 days) versus those without dose r/d	Most common reasons for r/d of ACEi/ARB were WRF, Hypotension and HK
Gilstrap et al., 2017	Analysis of (GWTG-HF) registry	16,052	90.5% patients continued and started ACEi/ARB	Incidence of WRF in each group: Continued ACEi/ARB: 11.84% Started: 11.38% Discontinued: 15.58%, Not started 13.23%	Incidence of SBP < 90: Continued: 2.80%, Started: 2.42%, Discontinued: 3.90%, Not started 1.82%	Incidence of HK Continued:2.37%, Started: 1.59%, Discontinued: 3.90%, Not started 2.40%	30-day mortality higher on discontinued group HR: 1.92; (1.32-2.81) versus continued group 30-day mortality higher on not started group HR 1.50;(1.12-2.00) vs started. 1-year mortality on discontinued group HR 1.35 (1.13-1.61), and not started group HR of 1.28 (1.14-1.43) was higher compared to continued and started group respectively.	1-year composite endpoint (mortality or readmission) was higher in those discontinued
Sanam et al., 2016	Retrospective chart review	1,384	734 patients were initiated on ACEi/ARB	NA	NA	NA	30-day all-cause mortality was lower in patients received ACEi/ARB compared to those who did not HR 0.56 (0.33-0.98).	Patients on ACEi/ARB had lower risk of 30-day all-cause readmission HR 0.74 (0.56-0.97)
Yoshioka et al., 2019	Post hoc analysis of the REALITY-AHF trial	900	ACEi/ARB initiation within 48 hour of admission vs no ACEi/ARB	148 patients had WRF within 5 days.	NA	NA	No significant difference was found for in-hospital mortality or incidence of WRF between two groups.	The ACEi/ARB group had significantly higher event-free survival HR 0.51 (0.32-0.82)
Siddiqui et al., 2015	Retrospective	8,049	Studied medicare beneficiaries hospitalized for HF	2,180 patients had WRF	NA	NA	30-day all-cause mortality occurred in 5% and 9% of patients receiving and not receiving ACEi or ARB, respectively HR 0.89 (0.79-1.00). Benefit persisted at 1-year	30-day all-cause readmission occurred in 21% and 27% of patients receiving and not receiving ACEi or ARB, respectively HR 0.77 (0.62-0.95)
Fudim et al., 2018	Post hoc analysis of ESCAPE trial	433	AHF (EF ≤ 30%) therapy guided by measures of decongestion	68 patients had temporary WRF, 67 had persistent WRF	NA	NA	Persistent congestion + WRF at discharge was associated with increased mortality HR 3.46 (1.89-6.31) compared to no WRF + no congestion. WRF was not significantly associated with 180-day all-cause death among decongested HR: 0.52 (0.20-1.35)	Persistent congestion with concomitant WRF at discharge was associated with worse outcomes compared to patients without congestion and WRF
Aronson and Burger, 2010	Post hoc analysis VMAC trial	467	Comparing the hemodynamic and clinical effects of Nesiritide to nitroglycerin	WRF occurred in 115 patients (24.2%) Persistent in 76 patients, Transient WRF in 39 patients	NA	NA	Increased mortality in patients with persistent WRF HR 3.2 (2.1-5.0). Mortality of patients with transient WRF was similar to that of patients without WRF HR 0.8 (0.4-1.7)	Transient WRF appears to be associated with a better outcome as compared with persistent WRF
Metra et al., 2018	A Post Hoc Analysis of the PROTECT Data	1,684	Rolofylline for AHF to Assess effect on Congestion and Renal Function	Only studied patients with WRF	NA	NA	WRF + congestion has higher 30-day mortality or HF hospitalization HR 1.49 (1.06-2.09) in congested patients. Congestion score ≤ 2 with WRF was not associated with worse outcomes HR 0.98 (0.76-1.27)	LOS because of WRF was 3.51 (1.29-5.73) more days
Metra et al., 2012	Prospective	599	Patients were subdivided into 4 groups according to development or not of WRF and the persistence of congestion at discharge	WRF + congestion: 45 patients. WRF + no congestion: 253 patients	NA	NA	WRF + congestion HR 2.44 (1.24, 4.81). WRF + no congestion HR 1.04 (0.62, 1.73)	WRF alone is not an independent determinant of outcomes in patients with AHF
Ahmad et al., 2018	Post hoc analysis of ROSE-AHF trial	283	High dose diuretics therapy and study of renal biomarkers	60 patients had WRF	NA	NA	WRF in aggressively diuresed patients was not associated with worsened 180-day survival (adjusted P = 0.84)	WRF in the setting of aggressive diuresis was not associated with renal tubular injury

Table 2 Studies showing the effects of mineralocorticoid receptor blockers and angiotensin II receptor blockers - neprilysin inhibitors in patients with acute heart failure.

First Author/ Year/ Reference	Study Design	N	Intervention	Outcomes				Major findings/comments
First Author/ Year/ Reference	Study Design	N	Intervention	Renal outcomes	Hypotension	Hyperkalemia (HK)	Mortality/CV outcomes	Major findings/comments
Ferreira et al., 2014	Prospective single center single blind	100	Standard therapy + spironolactone (treatment group) vs standard (control group)	WRF was more frequent in control group 20% (10 patients) vs. 4% (2 patients); P = 0.038).	NA	Serum potassium did not differ significantly between groups	Greater proportion of patients in the treatment group were free of congestion at day 3	NA
Maisel et al., 2014	Secondary analysis of COACH study	534	30-day outcome between patients treated with spironolactone vs not	Spironolactone treatment was significantly beneficial in groups with elevated SCr (P = 0.009)	NA	NA	Patients discharged on spironolactone had significantly less 30-day event (death or rehospitalization) HR 0.538 (0.299-0.968)	55% patients got spironolactone at discharge
Hamaguchi et al., 2010	Prospective	946	Prescription of Spironolactone at discharge	NA	NA	NA	All cause and cardiac death in spironolactone group was significantly reduced vs other HR 0.619 (0.413-0.928) and HR 0.524 (0.315-0.873) respectively	46% patients got spironolactone at discharge
Hernandez et al. , 2012	Retrospective. Medicare registry data	5,887	Studied patients who got MRA therapy (treated group) at discharge	NA	NA	30-day Incidence of HK was 2.9% vs 1.2% (P < .001) between treated vs not. 1-year (8.9% vs 6.3%)	No significant differences in mortality at 3-year between two groups HR 1.05 (0.97-1.15). 3-year HF readmission rate was lower among patients on MRA therapy at discharge HR 0.87 (0.77-0.98)	Significant increase in the risk of readmission with hyperkalemia at 30-day HR 2.54 (1.51-4.29) and 1-year HR 1.50 (1.23-1.84)
Tromp et al., 2017	Post hoc analysis of PROTECT trial	1,867	Studied association between HK at admission and mortality	NA	NA	176 patients (9%) had HK	Potassium levels at admission or its change during hospitalization are not associated with mortality after multivariate adjustment.	NA
Rossignol et al. , 2012	Post hoc analysis of EPHESUS trial	5,792	Post-acute MI patients were given Eplerenone vs placebo	914 patients had WRF (16.9% in eplerenoneand 14.7% in placebo). More frequent early decline in eGFR with Eplerenone	NA	Potassium level > 6 in 1 patient	Early WRF was independently associated with all-cause mortality, cardiovascular death. Eplerenone continued to show clinical benefit on CV outcomes on patients with early WRF.	Eplerenone is safe and beneficial in patients with HF after myocardial infarction with a SCr < 2.5 mg/dL and a serum potassium < 5.0 mmol/L
Greene et al., 2019	Post hoc analysis of ATHENA-HF	360	High dose Spironolactone (100mg) vs standard care (25 mg or placebo)	WRF from baseline to 96 hours/discharge were similar in 2 groups	NA	HK from baseline to 96 hours and 30-day were similar in 2 groups	eGFR ≤ 50 is associated with higher risk for mortality HR 12.11 (1.37-107.22)	High-dose spironolactone did not improve congestion more than usual care, irrespective of renal function
Oh et al., 2015	Retrospective	1,035	Studied MRA use in CKD	Patient with severe CKD 4-5 may not benefit from spironolactone	NA	Incidence of HK was 11.9% at admission, 3.6% at discharge, and 10.3% at 1 month after discharge	Spironolactone use was not an independent predictor of all-cause mortality after adjusting other HF risk factors HR 0.974 (0.681-1.392)	Spironolactone may not benefit AHF patients with severe renal dysfunction (eGFR < 45 mL/min per 1.73 m2)
Velazquez et al. , 2018	Randomized	881	ARNI vs enalapril group	No change in renal function between two groups RR 0.93 (0.67 -1.28)	No change in BP between two groups RR 1.18 (0.85-1.64)	No change in potassium between two groups RR 1.23 (0.84-1.84)	No change in mortality between two groups. 0.66 (0.3-1.48)	Greater reduction in NT-proBNP level in ANI group

1	Ahmad, T., Jackson, K., Rao, V. S., Tang, W. H. W., Brisco-Bacik, M. A., Chen, H. H., Felker, G. M., Hernandez, A. F., O'Connor, C. M., Sabbisetti, V. S., Bonventre, J. V., Wilson, F. P., Coca, S. G. and Testani, J. M. (2018) Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury. Circulation 137, 2016-2028.
2	Aronson , D. and Burger , A. J. (2010) The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure. Journal of Cardiac Failure 16, 541-547.
3	Chamsi-Pasha, M. A., Dupont, M., Al Jaroudi, W. A. and Tang, W. H. W. (2014) Utilization pattern of mineralocorticoid receptor antagonists in contemporary patients hospitalized with acute decompensated heart failure: a single-center experience. Journal of Cardiac Failure 20, 229-235.
4	Cooper, L. B., Lippmann, S. J., Greiner, M. A., Sharma, A., Kelly, J. P., Fonarow, G. C., Yancy, C. W., Heidenreich, P. A. and Hernandez, A. F. (2017) Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease. Journal of the American Heart Association6 6,e006540
5	Damman, K., Valente, M. A. E., Voors, A. A., O’Connor, C. M., Van Veldhuisen, D. J. and Hillege, H. L. (2014) Renal impairment, worsening renal function, and outcome in patients with heart failure: An updated meta-analysis. European Heart Journal 35, 455-469.
6	Desai, A. S., Claggett, B. L., Packer, M., Zile, M. R., Rouleau, J. L., Swedberg, K., Shi, V., Lefkowitz, M., Starling, R., Teerlink, J., McMurray, J. J. V., Solomon, S. D. and PARADIGM-HF Investigators. (2016) Influence of sacubitril/valsartan (LCZ696) on 30-day readmission after heart failure hospitalization. Journal of the American College of Cardiology 68, 241-248.
7	Edner, M., Benson, L., Dahlström, U. and Lund, L. H. (2015). Association between renin-angiotensin system antagonist use and mortality in heart failure with severe renal insufficiency: a prospective propensity score-matched cohort study. European Heart Journal 36, 2318-2326.
8	Ferreira, J. P., Santos, M., Almeida, S., Marques, I., Bettencourt, P. and Carvalho, H. (2014). Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure. European Journal of Internal Medicine 25, 67-72.
9	Fudim, M., Loungani, R., Doerfler, S. M., Coles, A., Greene, S. J., Cooper, L. B., Fiuzat, M., O'Connor, C. M., Rogers, J. G., Mentz, R. J. (2018) Worsening renal function during decongestion among patients hospitalized for heart failure: Findings from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. American Heart Journal 204, 163-173.
10	Gayat, E., Hollinger, A., Cariou, A., Deye, N., Vieillard-Baron, A., Jaber, S., Chousterman, B. G., Lu, Q., Laterre, P. F., Monnet, X., Darmon, M., Leone, M., Guidet, B., Sonneville, R., Lefrant, J. Y., Fournier, M. C., Resche-Rigon, M., Mebazaa, A., Legrand, M. and FROG-ICU investigators. (2018) Impact of angiotensin-converting enzyme inhibitors or receptor blockers on post-ICU discharge outcome in patients with acute kidney injury. Intensive Care Medicine 44, 598-605.
11	Gilstrap, L. G., Fonarow, G. C., Desai, A. S., Liang, L., Matsouaka, R., DeVore, A. D., Smith, E. E., Heidenreich, P., Hernandez, A. F., Yancy, C. W. and Bhatt, D. L. (2017) Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. Journal of the American Heart Association 6, e004675
12	Gottlieb, S. S., Abraham, W., Butler, J., Forman, D. E., Loh, E., Massie, B. M., O'connor, C. M., Rich, M. W., Stevenson, L. W., Young, J. and Krumholz, H. M. (2002) The prognostic importance of different definitions of worsening renal function in congestive heart failure. Journal of Cardiac Failure 8, 136-141.
13	Greene, S. J., Felker, G. M., Giczewska, A., Kalogeropoulos, A. P., Ambrosy, A. P., Chakraborty, H., DeVore, A. D., Fudim, M., McNulty, S. E., Mentz, R. J., Vaduganathan, M., Hernandez, A. F. and Butler, J. (2019) Spironolactone in acute heart failure patients with renal dysfunction and risk factors for diuretic resistance: from the ATHENA-HF trial. The Canadian Journal of Cardiology 35, 1097-1105.
14	Hamaguchi, S., Kinugawa, S., Tsuchihashi-Makaya, M., Goto, K., Goto, D., Yokota, T., Yamada, S., Yokoshiki, H., Takeshita, A. and Tsutsui, H. (2010) Spironolactone use at discharge was associated with improved survival in hospitalized patients with systolic heart failure. American Heart Journal 160, 1156-1162.
15	Hernandez, A. F., Mi, X., Hammill, B. G., Hammill, S. C., Heidenreich, P. A., Masoudi, F. A., Qualls, L. G., Peterson, E. D., Fonarow, G. C. and Curtis, L. H. (2012) Associations between aldosterone antagonist therapy and risks of mortality and readmission among patients with heart failure and reduced ejection fraction. JAMA-Journal of the American Medical Association 308, 2097-2107.
16	Iglesias, J., Ghetiya, S., Ledesma, K. J., Patel, C. S. and Levine, J. S. (2019). Interactive and potentially independent roles of renin-angiotensin-aldosterone system blockade and the development of cardiorenal syndrome type 1 on in-hospital mortality among elderly patients admitted with acute decompensated congestive heart failure. International Journal of Nephrology and Renovascular Disease 12, 33-48.
17	Kane, J. A., Kim, J. K., Haidry, S. A., Salciccioli, L. and Lazar, J. (2017) Discontinuation/dose reduction of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers during acute decompensated heart failure in African-American patients with reduced left-ventricular ejection fraction. Cardiology (Switzerland)137, 121-125.
18	Luo, N., Fonarow, G. C., Lippmann, S. J., Mi, X., Heidenreich, P. A., Yancy, C. W., Greiner, M. A., Hammill, B. G., Hardy, N. C., Turner, S. J., Laskey, W. K., Curtis, L. H., Hernandez, A. F., Mentz, R. J. and O’Brien, E. C. (2017) Early adoption of sacubitril/valsartan for patients with heart failure with reduced ejection fraction: insights from get with the guidelines-heart failure (GWTG-HF). JACC. Heart Failure 5, 305-309.
19	Maisel, A., Xue, Y., van Veldhuisen, D. J., Voors, A. A., Jaarsma, T., Pang, P. S., Butler, J., Pitt, B., Clopton, P. and de Boer, R. A. (2014) Effect of spironolactone on 30-day death and heart failure rehospitalization (from the COACH Study).[Erratum appears in Am J Cardiol. 2014 Nov 15;114(10):1628]. American Journal of Cardiology 114, 737-742.
20	Mcmurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., Rouleau, J. L., Shi, V. C., Solomon, S. D., Swedberg, K. and Zile, M. R. (2014). Angiotensin-neprilysin inhibition versus enalapril in heart failure. New Journal of Medicine 11, 993-1004.
21	Metra, M., Cotter, G., Senger, S., Edwards, C., Cleland, J. G., Ponikowski, P., Cursack, G. C., Milo, O., Teerlink, J. R., Givertz, M. M., O'Connor, C. M., Dittrich, H. C., Bloomfield, D. M., Voors, A. A. and Davison, B. A. (2018) Prognostic Significance of creatinine increases during an acute heart failure admission in patients with and without residual congestion. Circulation: Heart Failure 11, 1-11.
22	Metra, M., Davison, B., Bettari, L., Sun, H., Edwards, C., Lazzarini, V., Piovanelli, B., Carubelli, V., Bugatti, S., Lombardi, C., Cotter, G. and Dei Cas, L. (2012) Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circulation. Heart Failure 5, 54-62.
23	Oh, J., Kang, S. M., Song, M. K., Hong, N., Youn, J. C., Han, S., Jeon, E. S., Cho, M. C., Kim, J. J., Yoo, B. S., Chae, S. C., Oh, B. H., Choi, D. J., Lee, M. M. and Ryu, K. H. (2015). Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry. American Heart Journal 169, 713-720.
24	Packham, D. K., Rasmussen, H. S., Lavin, P. T., El-Shahawy, M. A., Roger, S. D., Block, G., Qunibi, W., Pergola, P. and Singh, B. (2015). Sodium zirconium cyclosilicate in hyperkalemia. New England Journal of Medicine 372, 222-231.
25	Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J. and Wittes, J. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. The New England Journal of Medicine 341, 709-717.
26	Rossignol, P., Cleland, J. G. F., Bhandari, S., Tala, S., Gustafsson, F., Fay, R., Lamiral, Z., Dobre, D., Pitt, B. and Zannad, F. (2012). Determinants and consequences of renal function variations with aldosterone blocker therapy in heart failure patients after myocardial infarction: Insights from the eplerenone post-acute myocardial infarction heart failure efficacy and survival study. Circulation 125, 271-279.
27	Rossignol, P., Dobre, D., McMurray, J. J. V, Swedberg, K., Krum, H., van Veldhuisen, D. J., Shi, H., Messig, M., Vincent, J., Girerd, N., Bakris, G., Pitt, B. and Zannad, F. (2014). Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF). Circulation. Heart Failure 7, 51-58.
28	Sanam, K., Bhatia, V., Bajaj, N. S., Gaba, S., Morgan, C. J., Fonarow, G. C., Butler, J., Deedwania, P., Prabhu, S. D., Wu, W. C., White, M., Love, T. E., Aronow, W. S., Fletcher, R. D., Allman, R. M. and Ahmed, A. (2016). Renin-Angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure. The American Journal of Medicine 129, 1067-1073.
29	Siddiqui, M., Sanders, P. W., Arora, G., Morgan, C., Zhang, S., Prabhu, S. D., Agarwal, A., Cutter, G., Mehta, R. L., Deedwania, P., Fletcher, R. D., Fonarow, G. C., Butler, J., Aronow, W. S., Wu, W., Anker, S. D., Allman, R. M. and Ahmed, A. (2015). Use of ACE inhibitors or angiotensin receptor blockers is associated with a significantly lower risk of 30-day all-cause and heart failure readmissions and all-cause mortality in older medicare beneficiaries hospitalized for heart failure developing acute. Circulation 132, A19094.
30	Tromp, J., ter Maaten, J. M., Damman, K., O’Connor, C. M., Metra, M., Dittrich, H. C., Ponikowski, P., Teerlink, J. R., Cotter, G., Davison, B., Cleland, J. G., Givertz, M. M., Bloomfield, D. M., van der Wal, M. H., Jaarsma, T., van Veldhuisen, D. J., Hillege, H. L., Voors, A. A. and van der Meer, P. (2017). Serum potassium levels and outcome in acute heart failure (data from the protect and coach trials). American Journal of Cardiology 119, 290-296.
31	Velazquez, E. J., Morrow, D. A., DeVore, A. D., Duffy, C. I., Ambrosy, A. P., McCague, K., Rocha, R., Braunwald, E. and PIONEER-HF, Investigators. (2018) Angiotensin-neprilysin inhibition in acute decompensated heart failure. New England Journal of Medicine 380, 539-548.
32	Weir, M. R., Bakris, G. L., Bushinsky, D. A., Mayo, M. R., Garza, D., Stasiv, Y., Wittes, J., Christ-Schmidt, H., Berman, L., Pitt, B. and OPAL-HK Investigators. (2015) Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. New England Journal of Medicine 372, 211-221.
33	Yoshioka, K., Matsue, Y., Yamaguchi, T., Kitai, T., Kagiyama, N., Okumura, T., Kida, K., Oishi, S., Akiyama, E., Suzuki, S., Yamamoto, M., Kuroda, S., Matsumura, A. and Hirao, K. (2019) Safety and prognostic impact of early treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients with acute heart failure. American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions 1-9.

[1]	Amir Kazory, Maria Rosa Costanzo. The dynamic relationship between serum chloride and cardiorenal syndrome[J]. Reviews in Cardiovascular Medicine, 2020, 21(1): 25-29.
[2]	Faeq Husain-Syed, Horst-Walter Birk, Khodr Tello, Manuel J. Richter, Claudio Ronco, Peter A. McCullough, Tanja Schörmann, Fiorenza Ferrari, Gökhan Yücel, Babak Yazdani, Hans-Dieter Walmrath, Werner Seeger, Henning Gall, H. Ardeschir Ghofrani. Alterations in Doppler-derived renal venous stasis index during decompensation of right heart failure and fluid overload in a patient with pulmonary hypertension[J]. Reviews in Cardiovascular Medicine, 2019, 20(4): 263-266.
[3]	Janani Rangaswami, Sandeep Soman, Peter A. McCullough. Key updates in Cardio-Nephrology from 2018: springboard to a bright Future[J]. Reviews in Cardiovascular Medicine, 2018, 19(4): 113-116.
[4]	Anna Mollar, Gema MiúFana, Maria Pilar Villanueva, Jorge Guijarro, Julio NúþFez. Utility of Procalcitonin for Diagnosis of Superimposed Infections in Patients With Acute Heart Failure[J]. Reviews in Cardiovascular Medicine, 2016, 17(3-4): 144-148.
[5]	Maria Rosa Costanzo, L.S. Chawla, J.A. Tumlin, C.A. Herzog, Peter A. McCullough, J.A. Kellum, C. Ronco. The Role of Early and Sufficient Isolated Venovenous Ultrafiltration in Heart Failure Patients With Pulmonary and Systemic Congestion[J]. Reviews in Cardiovascular Medicine, 2013, 14(2-4): 123-133.
[6]	Haley Digiacomo, Andrew Shaw. The Complex Association Between Cardiac Disease and Kidney Dysfunction: Cardiorenal Syndrome, Contrast-Induced Nephropathy, and Cardiac Surgery-Associated Acute Kidney Injury[J]. Reviews in Cardiovascular Medicine, 2012, 13(4): 185-185.
[7]	Alberto Palazzuoli, Matteo Beltrami, Savina Nodari, Peter A. McCullough, Claudio Ronco. Clinical Impact of Renal Dysfunction in Heart Failure[J]. Reviews in Cardiovascular Medicine, 2011, 12(4): 186-199.
[8]	Tobias Breidthardt, Christopher W. McIntyre. Dialysis-Induced Myocardial Stunning: The Other Side of the Cardiorenal Syndrome[J]. Reviews in Cardiovascular Medicine, 2011, 12(1): 13-20.
[9]	Mihai Gheorghiade, David D. Shin, Tarita O. Thomas, Filippo Brandimarte, Gregg C. Fonarow, William T. Abraham. Congestion Is an Important Diagnostic and Therapeutic Target in Heart Failure[J]. Reviews in Cardiovascular Medicine, 2006, 7(S1): 12-24.
[10]	Leonardo De Luca, William T. Abraham, Gregg C. Fonarow<, Mihai Gheorghiade. Congestion in Acute Heart Failure Syndromes: Importance of Early Recognition and Treatment[J]. Reviews in Cardiovascular Medicine, 2006, 7(2): 69-74.
[11]	Gregg C. Fonarow. Pharmacologic Therapies for Acutely Decompensated Heart Failure[J]. Reviews in Cardiovascular Medicine, 2002, 3(S4): 18-27.

No Suggested Reading articles found!

Viewed

Full text

Abstract

Cited

Shared

Discussed

Home

About

Articles

Special issues

For authors

For reviewers

Alerts

Contact us

Cite this article:

URL: