Heart failure & cardiomyopathiesMeta-analysis
Combination Diuretic Therapy in Acute Heart Failure: A Systematic Review and Meta-Analysis
- Systematic review and meta-analysis of randomised trials
Authors' conclusion
In patients with AHF, a combination diuretic strategy improved early decongestion without affecting prognosis. The use of SGLT2i during index hospitalization was associated with an improvement in all-cause mortality and HF events.
Study context
- Population
- Patients with acute heart failure (HF)
- Participants
- 7,517 patients · 11 RCTs
- Comparison
- Combination diuretic strategy vs no combination
Pooled result
As reported in the abstract
All-cause death and HF events
Combination diuretic vs ControlRelative risk (95% CI)P value
all-cause death
0.97(0.89–1.07)
P = 0.55HF events
0.83(0.64–1.08)
P = 0.16Further pooled results
| Outcome | MD (95% CI) | P value | |
|---|---|---|---|
| Weight loss | −0.96 (−1.37 to −0.54) | P < 0.0001 | |
| Diuretic efficiency (weight change per mean daily loop diuretic dose) | −0.56 (−1.11 to −0.02) | P = 0.04 | |
| Daily urinary output | 266.26 (47.20–485.32) | P = 0.02 | |
| −2000200400600Difference (linear scale) |
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| HF events with SGLT2i during hospitalization | 0.66 (0.58–0.76) | P < 0.0001 | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Worsening renal function (serum creatinine increase >0.3 mg/dl and/or eGFR reduction >50% vs baseline) with SGLT2i | 0.69 (0.50–0.96) | P = 0.03 | |
| 0.512Relative risk (log scale) |
Original publication
Combination Diuretic Therapy in Acute Heart Failure: A Systematic Review and Meta-Analysis. Eur J Heart Fail. Published 10 December 2025. doi:10.1002/ejhf.70094
Summarised from the published abstract; every number is checked against it