Recommendations for Therapies in the Hospitalized HF Patient Recommendations COR LOE References HF patients hospitalized with fluid overload should be treated with intravenous diuretics I B 310,311 HF patients receiving loop diuretic therapy should receive an initial parenteral dose greater than or equal to their chronic oral daily dose; then dose should be serially adjusted I B 312 HFrEF patients requiring HF hospitalization on GDMT should continue GDMT except in cases of hemodynamic instability or where contraindicated I B 307 309 Initiation of beta-blocker therapy at a low dose is recommended after optimization of volume status and discontinuation of intravenous agents I B 307 309 Thrombosis/thromboembolism prophylaxis is recommended for patients hospitalized with HF I B 22,324 328 Serum electrolytes, urea nitrogen, and creatinine should be measured during titration of HF medications, including diuretics I C N/A When diuresis is inadequate, it is reasonable to IIa a. give higher doses of intravenous loop diuretics; or b. add a second diuretic (e.g., thiazide) B 313 316 Low-dose dopamine infusion may be considered with loop diuretics to improve diuresis IIb B 317,318 Ultrafiltration may be considered for patients with obvious volume overload IIb B 319 Ultrafiltration may be considered for patients with refractory congestion IIb C N/A Intravenous nitroglycerin, nitroprusside, or nesiritide may be considered an adjuvant to diuretic therapy for stable patients with HF IIb A 320 323 In patients hospitalized with volume overload and severe hyponatremia, vasopressin antagonists may be considered IIb B 330,331 COR indicates Class of Recommendation; GDMT, guideline-directed medical therapy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; LOE, Level of Evidence; and N/A, not available. No No Warm and Dry Cold and Dry Yes Yes Warm and Wet Cold and Wet Congestion at rest? (e.g. 