Diuretic therapy in chronic heart failure : implications for heart failure nurse specialists

Chronic heart failure (CHF) is a syndrome precipitated by inadequate cardiac output and neurohormonal activation, leading to sodium and water retention. With increasing prevalence of CHF, heart failure nurse specialists (HFNS) are becoming involved in collaborative models of care in community and outpatient settings. Diuretic therapy in both acute and chronic heart failure is effective in relieving symptoms of congestion and improving cardiovascular haemodynamics. Best practice guidelines dictate diuretics should not be used as monotherapy but serve as an adjunctive therapy to agents with demonstrated survival benefit, such as angiotensin,converting enzyme (ACE) inhibitors and beta-blocker therapy. Despite the widespread use of diuretic therapy, limited clinical trial evidence exists upon which to base treatment decisions and algorithms. This article seeks to review diuretic therapy and flexible diuretic regimes in CHF and to discuss implications for patient management and advanced nursing practice.