In a patient with heart failure and preserved ejection fraction (HFpEF), which is the best initial diuretic strategy?

In a patient with heart failure and preserved ejection fraction (HFpEF), beginning furosemide is considered the best initial diuretic strategy due to its effectiveness in managing fluid overload. HFpEF is often characterized by symptoms related to congestion because of fluid retention, despite preserved ejection fraction. Furosemide, a loop diuretic, is particularly advantageous in these situations as it is efficient at promoting diuresis, which helps alleviate symptoms such as edema and shortness of breath that arise from volume overload.

The rapid action of furosemide allows for immediate relief of acute symptoms, making it the preferred choice for addressing fluid retention. Additionally, loop diuretics like furosemide are more effective than thiazide diuretics in treating the volume overload typically seen in heart failure patients. Initiating treatment with a diuretic such as furosemide sets the foundation for further cardiac management and symptom control.

While other options like initiating a beta-blocker or using spironolactone can be important components of heart failure management, they are not first-line interventions for managing acute fluid overload and congestion. Similarly, hydrochlorothiazide is less effective than furosemide in this context and is typically used