Management of Decompensated Heart Failure

Medication Adjustments

The European Society of Cardiology recommends increasing furosemide from 20mg to 40mg twice daily to manage decompensated heart failure, while monitoring renal function and electrolytes closely 1, 2, 4
The American Heart Association suggests maintaining the current beta-blocker dose until fluid status improves, as seen with metoprolol succinate ER 25mg daily 5
Consider uptitration of Entresto (sacubitril-valsartan) to the next dose level (49-51mg BID) once fluid status improves, as recommended by the American College of Cardiology 2

Daily weights should be tracked to monitor fluid status, and electrolytes, BUN, and creatinine should be checked within 3-5 days of diuretic adjustment, as suggested by the European Society of Cardiology 1
Monitor blood pressure and heart rate with each medication administration, holding medications per established parameters, and reassess respiratory status daily with lung examination 1
Repeat chest X-ray in 5-7 days to assess response to treatment, as recommended by the European Journal of Heart Failure 1

Implement moderate fluid restriction (1.5-2L/day) while treating acute pulmonary edema, and ensure a low-sodium diet (2g sodium/day), as suggested by the American Heart Association 1
Elevate the head of bed to improve respiratory mechanics and reduce pulmonary congestion, as recommended by the European Society of Cardiology 1

Monitor for worsening renal function, and consider reducing diuretic dose if creatinine increases >50% above baseline, as suggested by the European Journal of Heart Failure 1
Watch for electrolyte abnormalities, such as hypokalemia and hyponatremia, and maintain potassium supplementation, as recommended by the American College of Cardiology 1, 3
Avoid NSAIDs, as they can worsen heart failure and reduce diuretic efficacy, as suggested by the European Journal of Heart Failure and the American Heart Association 3, 6
Monitor for hypotension, and follow current hold parameters for SBP <110 mmHg for metoprolol and <120/60 mmHg for furosemide, as recommended by the European Society of Cardiology 1