{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:58:51Z","timestamp":1780613931569,"version":"3.54.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":218,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Oral diuretic treatment has limited efficacy in managing chronic heart failure (HF) patients. Novel strategies are needed to manage patients with refractory congestion despite optimal HF therapy and high-dose oral diuretic treatment. In the present study, we prospectively quantified the efficacy and safety of an ambulatory, weekly, high-dose parenteral diuresis strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Data from the prospective, randomized, cross-over controlled study for comparisons of diuresis efficacy in HF patients (DEA-HF) were analysed. Chronic HF patients with congestion despite guideline-directed medical therapy were enrolled to receive three high-intensity diuretic regimens, once a week, in a randomized order: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg + oral metolazone 5 mg; and IV furosemide 250 mg + IV acetazolamide 500 mg. The primary outcome compared the total sodium excretion following each diuretic regimen. Here, all regimens were pooled to assess the effect of weekly intensive diuresis approach on congestion parameters. The study population included 42 patients, 40% females, with a mean age of 72 \u00b1 9 years. Following three consecutive weekly treatments, the mean body weight was decreased from 85.5 kg [95% confidence interval (CI): 79.7\u201391.2] to 83.1 kg (95% CI: 77.4\u201388.9. P = 0.0005), accompanied by a significant decrease in congestion score, N-terminal-pro-brain natriuretic peptide levels and lung ultrasound B-line count. Serum creatinine mildly but significantly increased from 1.81 mg\/dL (95% CI: 1.62\u20132.01) to 2.01 mg\/dL (95% CI: 1.81\u20132.21. P &amp;lt; 0.001), and no hospitalizations due to acute kidney injury occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with congestion-refractory HF, an ambulatory strategy utilizing high-intensity weekly IV diuretic therapy achieved effective decongestion without major safety concerns. This escalated strategy may improve clinical outcomes and prevent hospitalizations of chronic HF patients who require diuresis intensification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15358","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T07:35:04Z","timestamp":1752564904000},"page":"3285-3295","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of Ambulatory Intravenous Diuresis for Chronic Heart Failure Patients: Insights from the DEA-HF Trial"],"prefix":"10.1093","volume":"12","author":[{"given":"Amit","family":"Gruber","sequence":"first","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aharon (Ronnie)","family":"Abbo","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Volis","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doron","family":"Aronson","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurith\u00e9matique 1433, CHRU Nancy, INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Lund","family":"Kristensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital\u2014Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zukermann","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Alberkant","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Sitnitsky","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Kruger","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polina","family":"Khasis","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgeny","family":"Bravo","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boaz","family":"Elad","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludmila Helmer","family":"Levin","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren","family":"Caspi","sequence":"additional","affiliation":[{"name":"From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus , Haifa ,","place":["Israel"]},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion , Haifa ,","place":["Israel"]},{"name":"Clinical Research Institute at Rambam (CRIR) , Haifa ,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"2026021804201002700_ehf215358-bib-0001","doi-asserted-by":"publisher","first-page":"90","DOI":"10.15420\/cfr.2015.1.2.90","article-title":"Fluid management in patients with chronic heart failure","volume":"1","author":"Pellicori","year":"2015","journal-title":"Card Fail Rev"},{"key":"2026021804201002700_ehf215358-bib-0002","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1002\/ejhf.153","article-title":"Breathlessness at rest is not the dominant presentation of patients admitted with heart failure","volume":"16","author":"Shoaib","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0003","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026021804201002700_ehf215358-bib-0004","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1161\/CIR.0000000000001063","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"2026021804201002700_ehf215358-bib-0005","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in acute decompensated heart failure with volume overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N Engl J Med"},{"key":"2026021804201002700_ehf215358-bib-0006","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.cardfail.2023.07.017","article-title":"IV diuresis in alternative treatment settings for the management of heart failure: implications for mortality, hospitalizations and cost","volume":"30","author":"Jiang","year":"2024","journal-title":"J Card Fail"},{"key":"2026021804201002700_ehf215358-bib-0007","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1001\/jamacardio.2017.5250","article-title":"Outpatient worsening heart failure as a target for therapy: a review","volume":"3","author":"Greene","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2026021804201002700_ehf215358-bib-0008","first-page":"419","article-title":"An advanced chronic heart failure day care service: a 5 year single-center experience","volume":"11","author":"Freimark","year":"2009","journal-title":"Isr Med Assoc J"},{"key":"2026021804201002700_ehf215358-bib-0009","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1002\/ehf2.12677","article-title":"Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature","volume":"7","author":"Wierda","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0010","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1002\/ejhf.2503","article-title":"Practical outpatient management of worsening chronic heart failure","volume":"24","author":"Girerd","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0011","doi-asserted-by":"publisher","first-page":"3906","DOI":"10.1002\/ehf2.13368","article-title":"Ambulatory intravenous furosemide for decompensated heart failure: safe, feasible, and effective","volume":"8","author":"Ahmed","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0012","doi-asserted-by":"publisher","first-page":"434","DOI":"10.4021\/jocmr1106w","article-title":"The role of outpatient intravenous diuretic therapy in a transitional care program for patients with heart failure: a case series","volume":"4","author":"Lazkani","year":"2012","journal-title":"J Clin Med Res"},{"key":"2026021804201002700_ehf215358-bib-0013","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.cardfail.2022.11.015","article-title":"Advanced practice provider urgent outpatient clinic for patients with decompensated heart failure","volume":"29","author":"Rosner","year":"2023","journal-title":"J Card Fail"},{"key":"2026021804201002700_ehf215358-bib-0014","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1016\/j.ejheart.2008.01.003","article-title":"Outpatient intravenous diuretic therapy; potential for marked reduction in hospitalisations for acute decompensated heart failure","volume":"10","author":"Ryder","year":"2008","journal-title":"Eur J Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0015","doi-asserted-by":"publisher","first-page":"245","DOI":"10.14740\/jocmr4499","article-title":"Outpatient intravenous diuretic clinic: an effective strategy for management of volume overload and reducing immediate hospital admissions","volume":"13","author":"Verma","year":"2021","journal-title":"J Clin Med Res"},{"key":"2026021804201002700_ehf215358-bib-0016","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1002\/ehf2.14168","article-title":"Outpatient treatment of worsening heart failure with intravenous diuretics: first results from a multicentre 2-year experience","volume":"10","author":"Wierda","year":"2023","journal-title":"ESC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0017","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jchf.2015.06.017","article-title":"Intravenous diuretic therapy for the management of heart failure and volume overload in a multidisciplinary outpatient unit","volume":"4","author":"Buckley","year":"2016","journal-title":"JACC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0018","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2217\/fca-2023-0071","article-title":"Reduced heart failure-related healthcare costs with Furoscix versus in-hospital intravenous diuresis in heart failure patients: the FREEDOM-HF study","volume":"19","author":"Bensimhon","year":"2023","journal-title":"Future Cardiol"},{"key":"2026021804201002700_ehf215358-bib-0019","doi-asserted-by":"publisher","first-page":"200","DOI":"10.18773\/austprescr.2022.069","article-title":"Diuretics in the management of chronic heart failure: when and how","volume":"45","author":"Magdy","year":"2022","journal-title":"Aust Prescr"},{"key":"2026021804201002700_ehf215358-bib-0020","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2024.04.014","article-title":"Diuresis efficacy in ambulatory congested heart failure patients: intra-patient comparison of three diuretic regimens (DEA-HF)","author":"Abbo","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0021","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"2026021804201002700_ehf215358-bib-0022","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1016\/j.jchf.2024.04.002","article-title":"Contemporary decongestion strategies in patients hospitalized for heart failure: a national community-based cohort study","volume":"12","author":"Zheng","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0023","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1161\/CIRCULATIONAHA.117.030112","article-title":"Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury","volume":"137","author":"Ahmad","year":"2018","journal-title":"Circulation"},{"key":"2026021804201002700_ehf215358-bib-0024","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.123.011751","article-title":"Absence of kidney tubular injury in patients with acute heart failure with acute kidney injury","volume":"17","author":"Duff","year":"2024","journal-title":"Circ Heart Fail"},{"key":"2026021804201002700_ehf215358-bib-0025","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.cardfail.2016.06.423","article-title":"Relevance of changes in serum creatinine during a heart failure trial of decongestive strategies: insights from the DOSE trial","volume":"22","author":"Brisco","year":"2016","journal-title":"J Card Fail"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/5\/3285\/66969716\/eschf_12_5_3285.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/5\/3285\/66969716\/eschf_12_5_3285.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:20:17Z","timestamp":1771406417000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/12\/5\/3285\/8488244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,7,15]]},"published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15358","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,7,15]]},"assertion":[{"value":"2025-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}