{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T14:51:30Z","timestamp":1792594290236,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":176,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"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":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Diuretic resistance (DR) in acute decompensated heart failure (ADHF) is associated with poor outcomes. The CLOROTIC trial demonstrated hydrochlorothiazide (HCTZ) with intravenous furosemide improved weight loss in ADHF. We assessed performance of the BAN-ADHF DR score and association between DR risk and HCTZ treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We included participants from CLOROTIC and assessed BAN-ADHF performance in identifying lowest net diuretic efficiency phenogroup, as identified with a random forest classifier. Participants were stratified by the BAN-ADHF score (\u226412: low DR risk and &amp;gt;12: high DR risk) to compare treatment effect of HCTZ versus placebo across DR risk. Outcomes were weight change and area under the curve (AUC) of dyspnoea visual analogue scale (VAS) at 72\/96\u2009h, fluid loss at 72\u2009h, and 30\/90-day mortality. Among 220 participants (50.9% male, mean age 83\u2009years), the BAN-ADHF score demonstrated good performance in identifying low net diuretic efficiency phenogroup (area under the receiver operating characteristic curve: 0.81). Weight change and VAS AUC at 72\u2009h was similar across DR risk strata, however, participants with high versus low DR risk had lower fluid loss at 72\u2009h (686 vs. 889\u2009ml, p\u2009=\u20090.003), higher 30-day (11.1% vs. 2.4%, p\u2009=\u20090.035) and 90-day mortality (23.0% vs. 10.6%, p\u2009=\u20090.033). The treatment effect of HCTZ (vs. placebo) on weight change was similar across DR risk (pint\u2009=\u20090.75 at 72\u2009h; pint\u2009=\u20090.50 at 96\u2009h). DR risk modified efficacy of HCTZ versus placebo on dyspnoea VAS, with high (vs. low) DR risk having attenuated improvement at 72\u2009h (\u2212236 vs. 476\u2009mm; pint\u2009=\u20090.03) and 96\u2009h (\u2212400 vs. 777\u2009mm; pint\u2009=\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BAN-ADHF score demonstrated good performance in identifying DR, and high DR risk was associated with worse outcomes. HCTZ treatment response on weight loss was similar across DR risk, but improvement in dyspnoea with HCTZ was attenuated in high DR risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.70002","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T08:36:12Z","timestamp":1756197372000},"page":"3142-3150","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diuretic Resistance and the Efficacy of Hydrochlorothiazide in Acute Decompensated Heart Failure: A Post-Hoc Analysis of the CLOROTIC Trial"],"prefix":"10.1093","volume":"27","author":[{"given":"Ambarish","family":"Pandey","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, UT Southwestern Medical Center , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Segar","sequence":"additional","affiliation":[{"name":"Division Cardiology, Texas Heart Institute , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Keshvani","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute , Dallas, TX ,","place":["USA"]},{"name":"The Heart Hospital, Baylor Scott and White , Plano, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"Ll\u00e1cer","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital de Manises, Avinguda de la Generalitat, Valenciana , Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Casado","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Universitario de Getafe, Carretera de Madrid-Toledo , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"Morales-Rull","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Internal Medicine Department, Hospital Universitari Arnau de Villanova, Institut de Recerca Biom\u00e9dica (IRBLleida) , Lleida ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Formiga","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Manzano","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Universitario Ram\u00f3n y Cajal, IRYCIS, Universidad de Alcal\u00e1 , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriette G.C.","family":"Van Spall","sequence":"additional","affiliation":[{"name":"Department of Medicine and Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University , Hamilton, ON ,","place":["Canada"]},{"name":"Population Health Research Institute , Hamilton ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan Carles","family":"Trull\u00e0s","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital d'Olot i Comarcal de la Garrotxa , Girona ,","place":["Spain"]},{"name":"Laboratori de Reparaci\u00f3 i Regeneraci\u00f3 Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"2026021721521941500_ejhf70002-bib-0001","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.jacc.2012.12.038","article-title":"Heart failure-associated hospitalizations in the United States","volume":"61","author":"Blecker","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026021721521941500_ejhf70002-bib-0002","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.121.008335","article-title":"Trends in 30- and 90-day readmission rates for heart failure","volume":"14","author":"Khan","year":"2021","journal-title":"Circ Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0003","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1161\/HYPERTENSIONAHA.120.15205","article-title":"Pathophysiology of diuretic resistance and its implications for the management of chronic heart failure","volume":"76","author":"Wilcox","year":"2020","journal-title":"Hypertension"},{"key":"2026021721521941500_ejhf70002-bib-0004","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11897-019-0424-1","article-title":"Diuretic resistance in heart failure","volume":"16","author":"Gupta","year":"2019","journal-title":"Curr Heart Fail Rep"},{"key":"2026021721521941500_ejhf70002-bib-0005","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.ahj.2015.05.003","article-title":"Diuretic response in acute heart failure \u2013 an analysis from ASCEND-HF","volume":"170","author":"Maaten","year":"2015","journal-title":"Am Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0006","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1093\/eurheartj\/ehu065","article-title":"Diuretic response in acute heart failure: Clinical characteristics and prognostic significance","volume":"35","author":"Valente","year":"2014","journal-title":"Eur Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0007","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1161\/CIRCHEARTFAILURE.113.000895","article-title":"Loop diuretic efficiency: A metric of diuretic responsiveness with prognostic importance in acute decompensated heart failure","volume":"7","author":"Testani","year":"2014","journal-title":"Circ Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0008","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1136\/hrt.72.2_Suppl.S40","article-title":"Pharmacokinetics of loop diuretics in congestive heart failure","volume":"72","author":"Brater","year":"1994","journal-title":"Br Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0009","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/ejhf.757","article-title":"Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure","volume":"19","author":"Ter Maaten","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0010","first-page":"F374","article-title":"Structural adaptation of the distal convoluted tubule to prolonged furosemide treatment","volume":"248","author":"Kaissling","year":"1985","journal-title":"Am J Physiol"},{"key":"2026021721521941500_ejhf70002-bib-0011","doi-asserted-by":"crossref","first-page":"3414","DOI":"10.1681\/ASN.2016111178","article-title":"Compensatory distal reabsorption drives diuretic resistance in human heart failure","volume":"28","author":"Rao","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026021721521941500_ejhf70002-bib-0012","doi-asserted-by":"crossref","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","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":"79","author":"Heidenreich","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026021721521941500_ejhf70002-bib-0013","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/eurheartj\/ehac689","article-title":"Combining loop with thiazide diuretics for decompensated heart failure: The CLOROTIC trial","volume":"44","author":"Trullas","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0014","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.jchf.2023.09.029","article-title":"A Phenomapping tool and clinical score to identify low diuretic efficiency in acute decompensated heart failure","volume":"12","author":"Segar","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0015","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.cardfail.2015.11.003","article-title":"Rationale and design of the \u201cSafety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) trial\u201d: A double-blind, randomized, placebo-controlled study to determine the effect of combined diuretic therapy (loop diuretics with thiazide-type diuretics) among patients with decompensated heart failure","volume":"22","author":"Trullas","year":"2016","journal-title":"J Card Fail"},{"key":"2026021721521941500_ejhf70002-bib-0016","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer"},{"key":"2026021721521941500_ejhf70002-bib-0017","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.amjcard.2025.02.018","article-title":"Adequacy of loop diuretic dosing in treatment of acute heart failure: Insights from the BAN-ADHF diuretic resistance risk score","volume":"244","author":"Mauch","year":"2025","journal-title":"Am J Cardiol"},{"key":"2026021721521941500_ejhf70002-bib-0018","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/j.jacc.2010.06.034","article-title":"Combination of loop diuretics with thiazide-type diuretics in heart failure","volume":"56","author":"Jentzer","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"2026021721521941500_ejhf70002-bib-0019","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1093\/eurheartj\/ehp253","article-title":"Effects of tolvaptan on dyspnoea relief from the EVEREST trials","volume":"30","author":"Pang","year":"2009","journal-title":"Eur Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0020","doi-asserted-by":"crossref","first-page":"3672","DOI":"10.1093\/eurheartj\/ehad557","article-title":"Renal function and decongestion with acetazolamide in acute decompensated heart failure: The ADVOR trial","volume":"44","author":"Meekers","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0021","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1002\/ejhf.2988","article-title":"Combining loop and thiazide diuretics for acute heart failure across the estimated glomerular filtration rate spectrum: A post-hoc analysis of the CLOROTIC trial","volume":"25","author":"Trullas","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0022","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1002\/ejhf.3537","article-title":"Diuretic efficiency of a single dose of subcutaneous versus oral furosemide after heart failure hospitalization across diuretic resistance strata: A pilot randomized controlled trial","volume":"27","author":"Keshvani","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026021721521941500_ejhf70002-bib-0023","doi-asserted-by":"crossref","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":"2026021721521941500_ejhf70002-bib-0024","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1038\/s41591-023-02532-z","article-title":"Natriuresis-guided diuretic therapy in acute heart failure: A pragmatic randomized trial","volume":"29","author":"Ter Maaten","year":"2023","journal-title":"Nat Med"},{"key":"2026021721521941500_ejhf70002-bib-0025","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/eurheartj\/ehac530","article-title":"Impact of empagliflozin on decongestion in acute heart failure: The EMPULSE trial","volume":"44","author":"Biegus","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021721521941500_ejhf70002-bib-0026","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jchf.2019.09.012","article-title":"Diuretic strategies for loop diuretic resistance in acute heart failure: The 3T trial","volume":"8","author":"Cox","year":"2020","journal-title":"JACC Heart Fail"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/27\/12\/3142\/66836230\/eurjhf_27_12_3142.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/27\/12\/3142\/66836230\/eurjhf_27_12_3142.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T02:52:25Z","timestamp":1771383145000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/27\/12\/3142\/8470669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,8,26]]},"published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.70002","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,8,26]]},"assertion":[{"value":"2025-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}