{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:39:35Z","timestamp":1765964375756,"version":"3.48.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"23-24","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Heart failure significantly burdens healthcare systems. eHealth products could alleviate this burden by providing patients with recommendations for intensifying diuretic therapy. As evidence on guiding diuretic therapy is scarce, our goal was to identify clinical parameters that eHealth products can use to support heart failure patients in intensifying their diuretic therapy. A post-hoc analysis of the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF), comparing an NT-proBNP-guided management strategy with a symptom-guided strategy in elderly heart failure patients, was conducted. Clinical data were collected during patient evaluations at 1, 3, 6, and 12 months of follow-up. At each visit, any increase or new prescription of diuretic therapy was recorded as the outcome event. Mixed-effects logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI), investigating the relationship between the patient data and the odds of diuretic therapy intensification. In this retrospective analysis, 568 heart failure patients were included. Over a 12-month period, 2013 follow-up visits were conducted, during which diuretics were initiated or increased in 370 visits (18.4%). Higher New York Heart  Association (NYHA) classification (OR 2.60, 95%CI 1.94-3.50), presence of edema (OR 2.84, 95%CI 2.15-3.77), paroxysmal nocturnal dyspnea (OR 1.52, 95%CI 1.04-2.21), and orthopnea (OR 1.39, 95%CI 1.04-1.85) were significantly associated with the initiation or increase of diuretics. Dyspnea, edema, paroxysmal nocturnal dyspnea, and orthopnea are associated with the intensification of diuretic treatment in HF patients. These symptoms, which patients can easily report, should be integrated into eHealth devices that offer guidance on managing diuretic therapy.<\/jats:p>","DOI":"10.1007\/s00508-025-02551-5","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T07:36:07Z","timestamp":1750145767000},"page":"774-777","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying patients\u2019 signs and symptoms to guide eHealth-directed diuretic therapy intensification in heart failure\u2014Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF)"],"prefix":"10.1007","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4184-9866","authenticated-orcid":false,"given":"Arno J.","family":"Gingele","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casper","family":"Eurlings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josiane J.","family":"Boyne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"issue":"17","key":"2551_CR1","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","volume":"118","author":"G Savarese","year":"2023","unstructured":"Savarese\u00a0G, Becher\u00a0PM, Lund\u00a0LH, Seferovic\u00a0P, Rosano\u00a0GMC, Coats\u00a0AJS. Global burden of heart failure: a\u00a0comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272\u20138710.","journal-title":"Cardiovasc Res"},{"key":"2551_CR2","doi-asserted-by":"publisher","first-page":"102541","DOI":"10.1016\/j.eclinm.2024.102541","volume":"71","author":"MRC Clemente","year":"2024","unstructured":"Clemente\u00a0MRC, Felix\u00a0N, Navalha\u00a0DDP, Pasqualotto\u00a0E, Morgado Ferreira\u00a0RO, Braga\u00a0MAP, et\u00a0al. Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a\u00a0systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine. 2024;71:102541. https:\/\/doi.org\/10.1016\/j.eclinm.2024.102541.","journal-title":"EClinicalMedicine"},{"issue":"1","key":"2551_CR3","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/ejhf.2008","volume":"23","author":"T Jaarsma","year":"2021","unstructured":"Jaarsma\u00a0T, Hill\u00a0L, Bayes-Genis\u00a0A, La Rocca\u00a0HB, Castiello\u00a0T, Celutkiene\u00a0J, et\u00a0al. Self-care of heart failure patients: practical management recommendations from the heart failure association of the European society of. Cardiol Eur J Heart Fail. 2021;23(1):157\u201374. https:\/\/doi.org\/10.1002\/ejhf.2008.","journal-title":"Cardiol Eur J Heart Fail"},{"issue":"2","key":"2551_CR4","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s11897-024-00643-3","volume":"21","author":"JJ Cuthbert","year":"2024","unstructured":"Cuthbert\u00a0JJ, Clark\u00a0AL. Diuretic treatment in patients with heart failure: current evidence and future directions\u2014part I:\u00a0loop diuretics. Curr Heart Fail Rep. 2024;21(2):101\u201314. https:\/\/doi.org\/10.1007\/s11897-024-00643-3.","journal-title":"Curr Heart Fail Rep"},{"issue":"4","key":"2551_CR5","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1001\/jama.2009.2","volume":"301","author":"M Pfisterer","year":"2009","unstructured":"Pfisterer\u00a0M, Buser\u00a0P, Rickli\u00a0H, Gutmann\u00a0M, Erne\u00a0P, Rickenbacher\u00a0P, et\u00a0al. BNP-guided vs symptom-guided heart failure therapy: the trial of intensified vs standard medical therapy in elderly patients with congestive heart failure (TIME-CHF) randomized trial. JAMA. 2009;301(4):383\u201392. https:\/\/doi.org\/10.1001\/jama.2009.2.","journal-title":"JAMA"},{"key":"2551_CR6","doi-asserted-by":"publisher","first-page":"728772","DOI":"10.3389\/fmed.2021.728772","volume":"8","author":"X Zhang","year":"2021","unstructured":"Zhang\u00a0X, Zhao\u00a0C, Zhang\u00a0H, Liu\u00a0W, Zhang\u00a0J, Chen\u00a0Z, et\u00a0al. Dyspnea measurement in acute heart failure: a\u00a0systematic review and evidence map of randomized controlled trials. Front Med. 2021;8:728772. https:\/\/doi.org\/10.3389\/fmed.2021.728772.","journal-title":"Front Med"},{"issue":"5","key":"2551_CR7","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/j.jchf.2021.01.011","volume":"9","author":"K Jering","year":"2021","unstructured":"Jering\u00a0K, Claggett\u00a0B, Redfield\u00a0MM, Shah\u00a0SJ, Anand\u00a0IS, Martinez\u00a0F, et\u00a0al. Burden of heart failure signs and symptoms, prognosis, and response to therapy: the PARAGON-HF trial. JACC Heart Fail. 2021;9(5):386\u201397. https:\/\/doi.org\/10.1016\/j.jchf.2021.01.011.","journal-title":"JACC Heart Fail"},{"issue":"1","key":"2551_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.36628\/ijhf.2019.0009","volume":"2","author":"M Bohm","year":"2020","unstructured":"Bohm\u00a0M, Bewarder\u00a0Y, Kindermann\u00a0I, Slawik\u00a0J, Wintrich\u00a0J, Werner\u00a0C. Optimization of heart failure treatment by heart rate reduction. Int J Heart Fail. 2020;2(1):1\u201311. https:\/\/doi.org\/10.36628\/ijhf.2019.0009.","journal-title":"Int J Heart Fail"},{"issue":"1","key":"2551_CR9","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1177\/1357633X211039404","volume":"30","author":"AJ Gingele","year":"2024","unstructured":"Gingele\u00a0AJ, Brandts\u00a0L, Vossen\u00a0K, Knackstedt\u00a0C, Boyne\u00a0J, Brunner-La\u00a0RHP. Prognostic value of signs and symptoms in heart failure patients using remote telemonitoring. J\u00a0Telemed Telecare. 2024;30(1):180\u20135. https:\/\/doi.org\/10.1177\/1357633X211039404.","journal-title":"J Telemed Telecare"},{"issue":"15","key":"2551_CR10","doi-asserted-by":"publisher","first-page":"1944","DOI":"10.1001\/jama.294.15.1944","volume":"294","author":"CS Wang","year":"2005","unstructured":"Wang\u00a0CS, FitzGerald\u00a0JM, Schulzer\u00a0M, Mak\u00a0E, Ayas\u00a0NT. Does this dyspneic patient in the emergency department have congestive heart failure? JAMA. 2005;294(15):1944\u201356. https:\/\/doi.org\/10.1001\/jama.294.15.1944.","journal-title":"JAMA"}],"container-title":["Wiener klinische Wochenschrift"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-025-02551-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00508-025-02551-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-025-02551-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:36:32Z","timestamp":1765964192000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00508-025-02551-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":10,"journal-issue":{"issue":"23-24","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2551"],"URL":"https:\/\/doi.org\/10.1007\/s00508-025-02551-5","relation":{},"ISSN":["0043-5325","1613-7671"],"issn-type":[{"type":"print","value":"0043-5325"},{"type":"electronic","value":"1613-7671"}],"subject":[],"published":{"date-parts":[[2025,6,17]]},"assertion":[{"value":"17 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A.J.\u00a0Gingele, C.\u00a0Eurlings, J.J.\u00a0Boyne and H.-P.\u00a0Brunner-La Rocca declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki. The investigation was approved by the local ethics committees. All the participants provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}