Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis
Abstract Aims Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study inv...
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Wiley
2025-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15275 |
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| author | M. Cobo Marcos R. de laEspriella I. Zegri‐Reiriz P. Llacer J. Rubio Gracia J. Comín‐Colet J. L. Morales‐Rull P. Diez‐Villanueva J. deJuan Bagudá S. Jiménez‐Marrero C. Ortiz Cortés M. A. Restrepo‐Córdoba J. M. García‐Pinilla E. Barrios S. delPrado Díaz J. Núñez |
| author_facet | M. Cobo Marcos R. de laEspriella I. Zegri‐Reiriz P. Llacer J. Rubio Gracia J. Comín‐Colet J. L. Morales‐Rull P. Diez‐Villanueva J. deJuan Bagudá S. Jiménez‐Marrero C. Ortiz Cortés M. A. Restrepo‐Córdoba J. M. García‐Pinilla E. Barrios S. delPrado Díaz J. Núñez |
| author_sort | M. Cobo Marcos |
| collection | DOAJ |
| description | Abstract Aims Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study investigated the prognostic value of both metrics in predicting 30‐day adverse clinical events in an ambulatory worsening heart failure (WHF) scenario. Methods and results This is a post‐hoc analysis of the SALT‐HF trial involving 167 patients with ambulatory WHF randomized to receive intravenous furosemide with or without hypertonic saline solution. Early diuretic response was assessed through 3‐h urine output and 3‐h urinary sodium (uNa+) levels following intravenous (IV) diuretic infusion. We analysed their association with 30‐day adverse events (defined as death, heart failure hospitalization, or the need for outpatient IV diuretics) using logistic regression analysis. Both exposures were examined along the continuum and dichotomized in their median. The discriminative ability between the exposures and endpoints was assessed by receiver operating characteristic curves (AUC‐ROC). Results The median age of participants was 81 years, predominantly male (69.5%). Patients with lower 3‐h urinary sodium and diuresis were older and exhibited reduced kidney function and haemoglobin levels. At 30 days, 50 (29.9%) of the sample experienced the composite endpoint. Multivariate analyses revealed that lower 3‐h uNa+ was associated with a higher risk of 30‐day adverse events (P = 0.008). Conversely, 3‐h diuresis did not significantly predict 30‐day adverse outcomes (P = 0.424). There was a trend towards a higher AUC‐ROC for the inverse of 3‐h natriuresis compared with 3‐h diuresis: 0.680 versus 0.601, P = 0.092. Conclusions In patients with ambulatory WHF treated with IV furosemide, 3‐h urinary sodium predicted 30‐day outcomes whereas 3‐h diuresis did not. |
| format | Article |
| id | doaj-art-8a5e76de03d24c7b9a0f178a75c4b294 |
| institution | Matheson Library |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-8a5e76de03d24c7b9a0f178a75c4b2942025-07-24T10:14:12ZengWileyESC Heart Failure2055-58222025-08-011242460246610.1002/ehf2.15275Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresisM. Cobo Marcos0R. de laEspriella1I. Zegri‐Reiriz2P. Llacer3J. Rubio Gracia4J. Comín‐Colet5J. L. Morales‐Rull6P. Diez‐Villanueva7J. deJuan Bagudá8S. Jiménez‐Marrero9C. Ortiz Cortés10M. A. Restrepo‐Córdoba11J. M. García‐Pinilla12E. Barrios13S. delPrado Díaz14J. Núñez15Department of Cardiology Hospital Universitario Puerta de Hierro Madrid SpainDepartment of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA) University of Valencia Valencia SpainDepartment of Cardiology Hospital de la Santa Creu i Sant Pau Barcelona SpainDepartment of Internal Medicine Hospital Universitario Ramón y Cajal, IRYCIS Madrid SpainDepartment of Internal Medicine, Hospital Universitario Lozano Blesa University of Zaragoza, Aragon Health Research Institute (IIS Aragon) Zaragoza SpainCentro de Investigación Biomédica en Red (CIBER Cardiovascular) Madrid SpainDepartment of Internal Medicine, Hospital Universitario Arnau de Vilanova, Heart Failure Unit Lleida Health Region, Institut de Recerca Biomèdica de Lleida (IRBLleida) Lleida SpainDepartment of Cardiology Hospital Universitario de la Princesa Madrid SpainCentro de Investigación Biomédica en Red (CIBER Cardiovascular) Madrid SpainCentro de Investigación Biomédica en Red (CIBER Cardiovascular) Madrid SpainDepartment of Cardiology Hospital Universitario San Pedro de Alcántara Cáceres SpainDepartment of Cardiology Hospital Universitario Clínico San Carlos Madrid SpainDepartment of Cardiology Hospital Universitario Virgen de la Victoria Málaga SpainDepartment of Cardiology Hospital Universitario Rey Juan Carlos Móstoles Madrid SpainCentro de Investigación Biomédica en Red (CIBER Cardiovascular) Madrid SpainCentro de Investigación Biomédica en Red (CIBER Cardiovascular) Madrid SpainAbstract Aims Early diuresis and natriuresis are commonly used to assess the efficacy of decongestive therapy following an acute heart failure episode. There is limited knowledge regarding which parameter better predicts adverse clinical outcomes, especially in the outpatient setting. This study investigated the prognostic value of both metrics in predicting 30‐day adverse clinical events in an ambulatory worsening heart failure (WHF) scenario. Methods and results This is a post‐hoc analysis of the SALT‐HF trial involving 167 patients with ambulatory WHF randomized to receive intravenous furosemide with or without hypertonic saline solution. Early diuretic response was assessed through 3‐h urine output and 3‐h urinary sodium (uNa+) levels following intravenous (IV) diuretic infusion. We analysed their association with 30‐day adverse events (defined as death, heart failure hospitalization, or the need for outpatient IV diuretics) using logistic regression analysis. Both exposures were examined along the continuum and dichotomized in their median. The discriminative ability between the exposures and endpoints was assessed by receiver operating characteristic curves (AUC‐ROC). Results The median age of participants was 81 years, predominantly male (69.5%). Patients with lower 3‐h urinary sodium and diuresis were older and exhibited reduced kidney function and haemoglobin levels. At 30 days, 50 (29.9%) of the sample experienced the composite endpoint. Multivariate analyses revealed that lower 3‐h uNa+ was associated with a higher risk of 30‐day adverse events (P = 0.008). Conversely, 3‐h diuresis did not significantly predict 30‐day adverse outcomes (P = 0.424). There was a trend towards a higher AUC‐ROC for the inverse of 3‐h natriuresis compared with 3‐h diuresis: 0.680 versus 0.601, P = 0.092. Conclusions In patients with ambulatory WHF treated with IV furosemide, 3‐h urinary sodium predicted 30‐day outcomes whereas 3‐h diuresis did not.https://doi.org/10.1002/ehf2.15275Ambulatory worsening heart failureDiuresisNatriuresisUrinary sodium |
| spellingShingle | M. Cobo Marcos R. de laEspriella I. Zegri‐Reiriz P. Llacer J. Rubio Gracia J. Comín‐Colet J. L. Morales‐Rull P. Diez‐Villanueva J. deJuan Bagudá S. Jiménez‐Marrero C. Ortiz Cortés M. A. Restrepo‐Córdoba J. M. García‐Pinilla E. Barrios S. delPrado Díaz J. Núñez Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis ESC Heart Failure Ambulatory worsening heart failure Diuresis Natriuresis Urinary sodium |
| title | Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis |
| title_full | Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis |
| title_fullStr | Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis |
| title_full_unstemmed | Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis |
| title_short | Early diuretic response and outcome prediction in ambulatory worsening heart failure: Natriuresis versus diuresis |
| title_sort | early diuretic response and outcome prediction in ambulatory worsening heart failure natriuresis versus diuresis |
| topic | Ambulatory worsening heart failure Diuresis Natriuresis Urinary sodium |
| url | https://doi.org/10.1002/ehf2.15275 |
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