Priority 8 from the Advanced Heart Failure PSP

UNCERTAINTY: What is the most effective way to use diuretics in advanced heart failure, with respect to, fluid overload, kidney function, survival & quality of life? (JLA PSP Priority 8)
Overall ranking 8
JLA question ID 0098/08
Explanatory note

No significant evidence for this care in the community  for people with advanced heart failure 
Evidence

Examples from hospital care 1. Heart Fail Rev. 2016 Sep;21(5):611-9. doi: 10.1007/s10741-016-9559-2.Defining the role of ultrafiltration therapy in acute heart failure: a systematic review and meta-analysis. 2. Jain A1, Agrawal N2, Kazory A3.Nephron. 2015;129(3):189-96. doi: 10.1159/000371447. Epub 2015 Feb 27.Effect of ultrafiltration versus intravenous furosemide for decompensated heart failure in cardiorenal syndrome: a systematic review with meta-analysis of randomized controlled trials.Chen HY1, Chou KJ, Fang HC, Chen CL, Hsu CY, Huang WC, Huang CW, Huang CK, Lee PT. 3. Int Heart J. 2015;56(2):192-5. doi: 10.1536/ihj.14-288. Epub 2015 Feb 23.Liberal versus restricted fluid administration in heart failure patients. A systematic review and meta-analysis of randomized trials.Li Y1, Fu B, Qian X.
Health Research Classification System category  Cardiovascular
Extra information provided by this PSP
Original uncertainty examples Is weighing daily an effective monitoring tool? How to improve balancing the impact on chronic kidney disease and heart failure? ~ What medication is best to use with severe heart failure and renal impairment? ~ How to manage cardio-renal syndrome or those at risk of this - how best to manage diuretics in late stage heart failure  ~ Should fluid intake be limited? We see patients with Continence issues so it relates directly to the advice we offer. ~ Do diuretics improve quality of life?  ~ How best to manage resistant fluid retention in advanced disease: 1. Parenteral furosemide or Metolazone: Which is more efficacious and less likely to worsen renal function? 2. Is SC Furosemide as effective as IV? ~ When to take the focus of 'dry weight'.
 
Submitted by  13 x health professionals 
PSP information
PSP unique ID 0098
PSP name Advanced Heart Failure
Total number of uncertainties identified by this PSP. 65  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 13 February 2019