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)|
|JLA question ID||0098/08|
No significant evidence for this care in the community for people with advanced heart failure
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 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|