{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:29:02Z","timestamp":1783211342155,"version":"3.54.6"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Urinary sodium (uNa+) is a promising tool to guide diuretic therapy in acute heart failure (AHF), yet its real-world adoption is uncertain. We aimed to evaluate current practices, perceived utility, and barriers to uNa\u207a-guided management among physicians managing AHF in Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide cross-sectional electronic survey in June 2025 of clinicians from cardiology, internal medicine, emergency medicine, and nephrology. The questionnaire assessed the frequency and timing of uNa+ monitoring in inpatient and outpatient settings, thresholds for poor response, therapeutic adjustments, and perceived benefits and barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 413 physicians responded: 138 (33%) from cardiology, 159 (39%) from internal medicine, 78 (19%) from emergency medicine, and 38 (9%) from nephrology. Overall, 70% reported measuring uNa+ during AHF hospitalization, but only 18% did so routinely. Outpatient application remained infrequent (32%). Nephrologists showed the highest usage in both inpatient (90%) and outpatient (61%) settings. The most frequent cut-off to define diuretic resistance was &amp;lt;50\u2005mmol\/l. Therapeutic strategies differed by specialty: loop diuretic escalation was more frequent in cardiology and emergency medicine, while thiazides were preferred in internal medicine and nephrology. Most participants (78%) considered uNa\u207a monitoring clinically useful. Major barriers included lack of standardized protocols, limited training, therapeutic inertia, and logistical constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While uNa\u207a monitoring is valued by clinicians, its use in AHF in Spain remains inconsistent across specialties. Addressing implementation barriers through education, protocols, and decision-support tools is critical to a broader adoption of uNa\u207a guided therapy in routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag006","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T12:42:18Z","timestamp":1767876138000},"source":"Crossref","is-referenced-by-count":2,"title":["Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9026-061X","authenticated-orcid":false,"given":"Marta","family":"Cobo Marcos","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Puerta de Hierro , C\/Joaqu\u00edn Rodrigo 2, 28222, Madrid ,","place":["Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBER) Cardiovascular , C\/ Monforte de Lemos 3-5, Pabell\u00f3n 11, 28029 Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-3475","authenticated-orcid":false,"given":"Joan Carles","family":"Trull\u00e0s","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital dOlot i comarcal de la Garrotxa , Girona ,","place":["Spain"]},{"name":"Laboratori de Reparaci\u00f3 i Regeneraci\u00f3 Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic\u2014Universitat Central de Catalunya , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Perez-Silvestre","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Consorcio Hospital General Universitario de Valencia , Valencia, Espa\u00f1a"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7924-9751","authenticated-orcid":false,"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Department of Emergency, Hospital Cl\u00ednic, \u2018Processes and Pathologies, Emergencies Research Group\u2019 IDIBAPS, University of Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-1929","authenticated-orcid":false,"given":"Borja","family":"Quiroga","sequence":"additional","affiliation":[{"name":"IIS-La Princesa, Nephrology Department, Hospital Universitario de la Princesa, RICORS-renal 2040 , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5955-2748","authenticated-orcid":false,"given":"Sonia","family":"Mirabet","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red (CIBER) Cardiovascular , C\/ Monforte de Lemos 3-5, Pabell\u00f3n 11, 28029 Madrid ,","place":["Spain"]},{"name":"Cardiology Department, Hospital Santa Creu i Sant Pau, Universitat Autonoma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7481-3678","authenticated-orcid":false,"given":"Gregorio","family":"Romero-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Medicine Department, University Hospital Germans Trias i Pujol, (HGiTP) & REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Universitat Aut\u00f2noma de Barcelona , Can Ruti Campus, Badalona ,","place":["Spain"]},{"name":"International Renal Research Institute of Vicenza , Vicenza 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