{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:04:50Z","timestamp":1792101890584,"version":"4.4.0"},"reference-count":45,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T00:00:00Z","timestamp":1687219200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>We assessed the effects of hypertonic saline solution (HSS) plus furosemide versus furosemide alone in patients with acute decompensated heart failure (ADHF). We searched four electronic databases for randomized controlled trials (RCTs) until June 30, 2022. The quality of evidence (QoE) was assessed using the GRADE approach. All meta\u2010analyses were performed using a random\u2010effects model. A trial sequential analysis (TSA) was also conducted for intermediate and biomarker outcomes. Ten RCTs involving 3013 patients were included. HSS plus furosemide significantly reduced the length of hospital stay (mean difference [MD]: \u22123.60 days; 95% confidence interval [CI]: \u22124.56 to \u22122.64; QoE: moderate), weight (MD: \u22122.34\u2009kg; 95% CI: \u22123.15 to \u22121.53; QoE: moderate), serum creatinine (MD: \u22120.41\u2009mg\/dL; 95% CI: \u22120.49 to \u22120.33; QoE: low), and type\u2010B natriuretic peptide (MD: \u2212124.26\u2009pg\/mL; 95% CI: \u2212207.97 to \u221240.54; QoE: low) compared to furosemide alone. HSS plus furosemide significantly increased urine output (MD: 528.57\u2009mL\/24\u2009h; 95% CI: 431.90 to 625.23; QoE: moderate), serum Na<jats:sup>+<\/jats:sup> (MD: 6.80\u2009mmol\/L; 95% CI: 4.92 to 8.69; QoE: low), and urine Na<jats:sup>+<\/jats:sup> (MD: 54.85\u2009mmol\/24\u2009h; 95% CI: 46.31 to 63.38; QoE: moderate) compared to furosemide alone. TSA confirmed the benefit of HSS plus furosemide. Due to the heterogeneity in mortality and heart failure readmission, meta\u2010analysis was not performed. Our study shows that HSS plus furosemide, compared to furosemide alone, improved surrogated outcomes in ADHF patients with low or intermediate QoE. Adequately powered RCTs are still needed to assess the benefit on heart failure readmission and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24033","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T04:54:31Z","timestamp":1687323271000},"page":"853-865","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The added value of hypertonic saline solution to furosemide monotherapy in patients with acute decompensated heart failure: A meta\u2010analysis and trial sequential analysis"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-2832","authenticated-orcid":false,"given":"Carlos","family":"Diaz\u2010Arocutipa","sequence":"first","affiliation":[{"name":"Vicerrectorado de Investigaci\u00f3n Universidad San Ignacio de Loyola Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Denegri\u2010Galvan","sequence":"additional","affiliation":[{"name":"Deparment of Cardiology Hospital Nacional Daniel Alcides Carri\u00f3n Callao Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7914-9788","authenticated-orcid":false,"given":"Lourdes","family":"Vicent","sequence":"additional","affiliation":[{"name":"Cardiology Department Hospital Universitario 12 de Octubre and Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12) Madrid Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Cardiovasculares (CIBERCV) Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Pariona","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Nacional Edgardo Rebagliati Martins Lima Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamas A.","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Keele UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian V.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Vicerrectorado de Investigaci\u00f3n Universidad San Ignacio de Loyola Lima Peru"},{"name":"Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group University of Connecticut\/Hartford Hospital Evidence\u2010Based Practice Center Hartford CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuab122"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1369"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.059"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.318186"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0000000000000310"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11897-019-0424-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/2048872618768488"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.10.012"},{"key":"e_1_2_9_10_1","first-page":"219","article-title":"Tolerability and efficacy of high\u2010dose furosemide and small\u2010volume hypertonic saline solution in refractory congestive heart failure","volume":"16","author":"Paterna S","year":"1999","journal-title":"Adv Ther"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_9_13_1","first-page":"401","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem H","year":"2011","journal-title":"JCE"},{"key":"e_1_2_9_14_1","unstructured":"HigginsJPT ThomasJ ChandlerJ et al. (editors).Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane; 2022.www.training.cochrane.org\/handbook"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0315-7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2011.11.087"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2003.166"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2014.01.012"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.05.025"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2010.11.003"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.01.059"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e31820f10ad"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13511"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.16-313"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00059-015-4327-y"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-0379-7"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-62-5-1003"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000047397"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15205"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12949"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.09.012"},{"key":"e_1_2_9_33_1","first-page":"216","article-title":"Adjunct hypertonic saline in patients with diffuse edema due to heart failure: a randomized double\u2010blinded clinical trial","volume":"20","author":"Mahjoob MP","year":"2021","journal-title":"Iran J Pharm Res"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0207242"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.005261"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000165065.82609.3D"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482940701210179"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-015-0254-9"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1388-9842(00)00094-5"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.09.004"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v9.i8.685"},{"key":"e_1_2_9_42_1","first-page":"612","article-title":"Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke","volume":"13","author":"Sacks D","year":"2018","journal-title":"Int J Stroke"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.11.010"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-020-00453-7"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.03.020"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.12439"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.24033","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T05:51:49Z","timestamp":1692683509000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.24033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,20]]},"references-count":45,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/clc.24033"],"URL":"https:\/\/doi.org\/10.1002\/clc.24033","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,20]]},"assertion":[{"value":"2023-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}