Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke* (211 213,217 219). (Level of Evidence: B) CLASS III: NO BENEFIT 1. Anticoagulation is not recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source (220 222). (Level of Evidence: B) CLASS III: NO BENEFIT 1. Statins are not bene cial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use (223 228). (Level of Evidence: A) CLASS IIa 1. Omega-3 polyunsaturated fatty acid supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations (229,230). (Level of Evidence: B) Table 10. Oral Diuretics Recommended for Use in the Treatment of Chronic HF Drug Initial Daily Dose(s) Maximum Total Daily Dose Duration of Action Loop diuretics Bumetanide 0.5 to 1.0 mg once or twice Furosemide 20 to 40 mg once or twice Thiazide diuretics Chlorothiazide 250 to 500 mg once or twice Hydrochlorothiazide 25 mg once or twice Indapamide 2.5 mg once 5 mg 36 h Metolazone 2.5 mg once 20 mg 12 to 24 h Potassium-sparing diuretics* Amiloride 5 mg once 20 mg 24 h Sequential nephron blockade Metolazonez 2.5 to 10.0 mg once plus loop diuretic N/A N/A Hydrochlorothiazide 25 to 100 mg once or twice plus loop diuretic N/A N/A Chlorothiazide (IV) 500 to 1,000 mg once plus loop diuretic N/A N/A *Eplerenone, although also a diuretic, is primarily used in chronic HF. yHigher doses may occasionally be used with close monitoring. zSee Section 7.3. HF indicates heart failure; IV, intravenous; and N/A, not applicable. 