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The aims were to (1) identify AHF patients with marked benefit or harm from specific treatments at hospital discharge and (2) predict mortality by quantifying the adrenomedullin system activity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a prospective multicentre study. AHF diagnosis and phenotype were centrally adjudicated by two independent cardiologists among patients presenting to the emergency department with acute dyspnoea. Adrenomedullin system activity was quantified using the biologically active component, bioactive adrenomedullin (bio-ADM), and a prohormone fragment, midregional proadrenomedullin (MR-proADM). Bio-ADM and MR-proADM concentrations were measured in a blinded fashion at presentation and at discharge. Interaction with specific treatments at discharge and the utility of these biomarkers on predicting outcomes during 365-day follow-up were assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 1886 patients with adjudicated AHF, 514 patients (27.3%) died during 365-day follow-up. After adjusting for age, creatinine, and treatment at discharge, patients with bio-ADM plasma concentrations above the median (&gt;\u200944.6\u00a0pg\/mL) derived disproportional benefit if treated with diuretics (interaction <jats:italic>p<\/jats:italic> values\u2009&lt;\u20090.001). These findings were confirmed when quantifying adrenomedullin system activity using MR-proADM (<jats:italic>n<\/jats:italic>\u2009=\u2009764) (interaction <jats:italic>p<\/jats:italic> values\u2009&lt;\u20090.001). Patients with bio-ADM plasma concentrations above the median were at increased risk of death (hazard ratio 1.87, 95% CI 1.57\u20132.24; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). For predicting 365-day all-cause mortality, both biomarkers performed well, with MR-proADM presenting an even higher predictive accuracy compared to bio-ADM (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Quantifying the adrenomedullin\u2019s system activity may help to personalise post-discharge diuretic treatment and enable accurate risk-prediction in AHF.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00392-021-01909-9","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T16:03:31Z","timestamp":1627056211000},"page":"627-637","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Activity of the adrenomedullin system to personalise post-discharge diuretic treatment in acute heart failure"],"prefix":"10.1007","volume":"111","author":[{"given":"Nikola","family":"Kozhuharov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leong","family":"Ng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Wussler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Strebel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Sabti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eltayeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain","family":"Squire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albina","family":"Nowak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Rieger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Michou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Stefanelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Puelacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samyut","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Belkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Lopez-Ayala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Struck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Bergmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Blet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle Menosi","family":"Gualandro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Breidthardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1120-6405","authenticated-orcid":false,"given":"Christian","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"1909_CR1","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1177\/2048872616633853","volume":"6","author":"\u00d2 Mir\u00f3","year":"2017","unstructured":"Mir\u00f3 \u00d2, Peacock FW, McMurray JJ et al (2017) European Society of Cardiology\u2014acute cardiovascular care association position paper on safe discharge of acute heart failure patients from the emergency department. 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In addition, Christian Mueller received lecture fees from Abbott, ALERE, BRAHMS, Novartis, and Roche. Nikola Kozhuharov was supported by grants from the Swiss National Science Foundation (P400PM-194477), Gottfried und Julia Bangerter-Rhyner-Stiftung, and the European Society of Cardiology. Iain Squire reports grants and personal fees from NOVARTIS, grants and personal fees from VIFOR, grants from BOEHRINGER INGELHEIM, grants from ASTRA ZENECA, grants from MERCK, outside the submitted work. Andreas Bergmann is the director of Sphingotec GmbH which is the manufacturer of Sphingotest bio-ADM diagnostic test. Joachim Struck and Oliver Hartmann are employed by Sphingotec GmbH. Christian Puelacher reports grants from Roche Diagnostics, outside the submitted work. Dr. Mebazaa reports personal fees from Orion, grants and personal fees from Roche, personal fees from Servier, personal fees from Otsuka, personal fees from Philips, grants and personal fees from Adrenomed, personal fees from Neuro Tronik, grants and personal fees from 4TEEN4, personal fees from Sanofi, outside the submitted work; and Alexandre Mebazaa owns shares of S-Form Pharma. Dr. Breidthardt has received research grants from the Swiss National Science Foundation (PASMP3-134362), the University Hospital Basel, the Department of Internal Medicine, University Hospital Basel, Abbott, and Roche as well as speaker honoraria from Roche. All the other authors declare that they have no conflict of interest with this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study complied with the Declaration of Helsinki and ethics approval was granted from the respective research ethics committees.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All the patients provided written informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All the authors have read and approved the manuscript.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}