{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:28:00Z","timestamp":1792027680585,"version":"4.4.0"},"reference-count":143,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response\/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.<\/jats:p>","DOI":"10.1002\/ejhf.1369","type":"journal-article","created":{"date-parts":[[2019,1,2]],"date-time":"2019-01-02T01:09:27Z","timestamp":1546391367000},"page":"137-155","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1019,"title":["The Use of Diuretics in Heart Failure with Congestion \u2014 A Position Statement from the Heart Failure Association of the European Society of Cardiology"],"prefix":"10.1093","volume":"21","author":[{"given":"Wilfried","family":"Mullens","sequence":"first","affiliation":[{"name":"Ziekenhuis Oost Limburg , Genk ,","place":["Belgium"]},{"name":"University of Hasselt , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Damman","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veli-Pekka","family":"Harjola","sequence":"additional","affiliation":[{"name":"Emergency Medicine, University of Helsinki, Helsinki University Hospital , Helsinki ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[{"name":"University of Paris Diderot, H\u00f4pitaux Universitaires Saint Louis Lariboisi\u00e8re, APHP, U 942 Inserm, F-CRIN INI-CRCT , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Center , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Martens","sequence":"additional","affiliation":[{"name":"Ziekenhuis Oost Limburg , Genk ,","place":["Belgium"]},{"name":"University of Hasselt , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Testani","sequence":"additional","affiliation":[{"name":"Yale University , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.H. Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Cleveland Clinic , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Orso","sequence":"additional","affiliation":[{"name":"University of Florence , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d'Investigations Clinique 1433 and Inserm U1116; CHRU Nancy; F-CRIN INI-CRCT , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens , Athens ,","place":["Greece"]},{"name":"University of Cyprus , Nicosia ,","place":["Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar M.","family":"Seferovic","sequence":"additional","affiliation":[{"name":"University of Belgrade, Faculty of Medicine , Belgrade ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsSpital Z\u00fcrich , Z\u00fcrich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Coats","sequence":"additional","affiliation":[{"name":"IRCCS, San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,1,1]]},"reference":[{"key":"2026080800370758600_ejhf1369-bib-0001","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s10741-007-9008-3","article-title":"An introduction to acute heart failure syndromes: definition and classification","volume":"12","author":"Filippatos","year":"2007","journal-title":"Heart Fail Rev"},{"key":"2026080800370758600_ejhf1369-bib-0002","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/hrt.2003.025270","article-title":"Clinical epidemiology of heart failure","volume":"93","author":"Mosterd","year":"2007","journal-title":"Heart"},{"key":"2026080800370758600_ejhf1369-bib-0003","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/ejhf.890","article-title":"Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry","volume":"19","author":"Chioncel","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026080800370758600_ejhf1369-bib-0004","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.jacc.2008.10.041","article-title":"Acute heart failure syndromes","volume":"53","author":"Gheorghiade","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2026080800370758600_ejhf1369-bib-0005","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/eurjhf\/hfp176","article-title":"Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure","volume":"12","author":"Nunez","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026080800370758600_ejhf1369-bib-0006","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1056\/NEJMra1703100","article-title":"Diuretic treatment in heart failure","volume":"377","author":"Ellison","year":"2017","journal-title":"N Engl J Med"},{"key":"2026080800370758600_ejhf1369-bib-0007","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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