Patient self-adjustment of diuretics in heart failure: evidence gaps despite guideline recommendations - insights from a scoping review
E O'donoghue, N Lucey, M Ledwidge, K Mcdonald, M RyderAbstract
Background
Heart Failure (HF) continues to pose challenges to the global healthcare system. Volume overload results in lengthy hospital admissions and a high level of contact with outpatient services. Diuretics are central to effective treatment of volume overload. Guidelines recommend adjustment of diuretic in response to worsening HF and self-adjustment of diuretic is recommended as part of an effective self-care strategy.
Purpose
This scoping review set out to answer the question "What is known about outpatient adjustment of diuretic for patients with HF?"
Methods
A scoping review was conducted in accordance with guidance set out by the Joanna Briggs Institute (JBI). Search terms were developed with clinical experts and a medical librarian. Five databases were searched and a search of grey literature was conducted on Google Scholar. In total, 39 papers were selected for data extraction and analysis.
Results
Across 39 publications, a total of 24,846 patients with HF were studied. The included publications comprised retrospective studies/analyses, randomised controlled trials (RCTs), pilot studies, case series and registry analyses. Self-assessment of volume status by the patient was reported in 11 studies whereas 22 studies specified volume assessment performed by the healthcare professional (HCP). Objective measurement of volume status was reported in eight papers, five of which have been published since 2021. Adjustment of diuretic by a HCP was reported in 26 papers. In contrast, self-adjustment of diuretic by patients was rare, reported in just nine of the included publications. Six studies reported the use of a protocol or algorithm to guide the patient in diuretic adjustment. No adverse events due to self-adjustment were reported.
Conclusion
This review analysed 39 publications dating from 1995 to present day. The way in which worsening heart failure (WHF) is being identified has evolved, with a growing emphasis on objective measurement. Guidelines recommend that patients are taught effective self-management strategies, including self-adjustment of diuretic. However, there is a dearth of literature on self-adjustment of diuretic, with no publication reporting on this since 2012. This contrasts with management of other chronic diseases such as diabetes or chronic pain, where effective support and education provision allow patients to adopt a more proactive approach to self-management and self-adjust their medications safely and effectively. Further research into supporting self-management of patients with HF is warranted.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.