{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:03:36Z","timestamp":1789538616674,"version":"build-2803163510"},"reference-count":27,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Recent randomized controlled trials (RCTs) showed improved decongestive response with intensified treatment during hospitalization for acute decompensated heart failure (ADHF). Nevertheless, none demonstrated long-term benefit, possibly due to lack of statistical power. We therefore pooled individual data from three recent RCTs to assess the clinical impact of intensified decongestive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Individual patient data from three RCTs evaluating decongestive strategies in ADHF\u2014acetazolamide (ADVOR), hydrochlorothiazide (CLOROTIC), and natriuresis-guided therapy (PUSH-AHF)\u2014were pooled. The primary endpoint was 90-day heart failure (HF) re-hospitalization and\/or all-cause mortality (adjusted for sex and trial). Secondary endpoints included 24- and 48-h diuresis, natriuresis, in-hospital mortality, and length of stay (LOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1059 patients (mean age 79, 42% female) hospitalized for ADHF were included. Baseline characteristics were similar, except for a higher proportion of men in the intensified treatment arm (63% vs 54%, P = .004). Intensified treatment did not reduce 90-day all-cause mortality and\/or HF readmissions (adjusted hazard ratio [HR] 1.03; 95% confidence interval [CI] 0.81\u20131.30); however, it was associated with lower in-hospital mortality (adjusted odds ratio [OR] 0.55; 95% CI 0.31\u20130.96; P = .038). Cumulative diuresis and natriuresis was significantly higher in patients with intensified treatment at 24 and 48 h (adjusted P &amp;lt; .001). There was no difference in doubling of serum creatinine at 3 days between the groups (adjusted P = .123). LOS was significantly shorter in patients in the intensified treatment arm (geometric mean of 9 [95% CI 8\u20139] days vs 10 [95% CI 9\u201310] days in the placebo group, adjusted P = .002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While intensified decongestive strategies in patients hospitalized for ADHF improve diuresis, natriuresis, and reduce LOS, no benefit was observed for post-discharge clinical outcomes. Although a potential reduction in in-hospital mortality was observed, this finding should be considered exploratory and hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag253","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:42:56Z","timestamp":1788370976000},"source":"Crossref","is-referenced-by-count":0,"title":["Contemporary decongestion strategies in acute heart failure: an individual patient data analysis of three randomized controlled trials"],"prefix":"10.1093","author":[{"given":"Lara E E C","family":"Zonneveld","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Martens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Oost-Limburg (ZOL) , Genk ,","place":["Belgium"]},{"name":"Department of Medicine and Life Science, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C","family":"Trull\u00e0s","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital d\u2019Olot,i comarcal, de la Garrotxa , Av dels Pasos Catalans, 86, Girona 17800 CA ,","place":["Spain"]},{"name":"Laboratori de Reparaci\u00f3 i Regeneraci\u00f3 Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic Universitat Central de Catalunya , Carretera de Roda, 70, Barcelona, CA 08500 Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0190-2228","authenticated-orcid":false,"given":"Kevin","family":"Damman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik H","family":"Verbrugge","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Diseases, University Hospital Brussels , Jette ,","place":["Belgium"]},{"name":"Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4605-3450","authenticated-orcid":false,"given":"Jeroen","family":"Dauw","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Aalst, AZORG Hospital , Aalst ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris E","family":"Beldhuis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Center Groningen , Hanzeplein 1, Groningen 9713 GZ ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Casado","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Getafe University Hospital , Madrid ,","place":["Spain"]},{"name":"Department of Medicine, Faculty of Medicine, Health and Sports, Universidad Europea de Madrid , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Lu\u00eds","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":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Oost-Limburg (ZOL) , Genk ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, Hasselt University , 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