{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T14:50:34Z","timestamp":1781967034658,"version":"3.54.5"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Stiftung f\u00fcr Klinische Forschung des Luzerner Kantonsspitals","award":["FP-2025-06"],"award-info":[{"award-number":["FP-2025-06"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess clinicians\u2019 decision-making in relation to guideline-recommended diuretic therapy, monitoring, and escalation strategies in acute heart failure (AHF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a multinational, case-based cross-sectional survey among clinicians involved in heart failure management in Switzerland, Germany, and Austria. Participants responded to standardized hypothetical clinical vignettes addressing loop diuretic dosing, monitoring, and management of insufficient diuretic response in patients with AHF. Multivariable binomial logistic regression was used to identify factors associated with guideline-concordant initial diuretic dosing and use of urinary sodium measurement. A total of 787 clinicians participated. Guideline-concordant initial loop diuretic dosing was reported by 53.4% of respondents for diuretic-naive patients and by 87.7% for patients receiving chronic diuretic therapy. Treatment monitoring using urinary sodium measurement was reported by 16.9%. In multivariable regression analysis, urinary sodium measurement was more frequent in Switzerland (OR 3.36; 95% CI 2.09\u20135.42) and Austria (OR 2.64; 95% CI 1.12\u20136.22) compared to Germany. General practitioners\/internal medicine physicians (OR 3.52, 95% CI 1.83\u20136.79), resident physicians (OR 2.60, 95% CI 1.50\u20134.51), and prehospital emergency physicians (OR 2.08, 95% CI 1.08\u20134.03) showed higher odds of urinary sodium measurement compared to emergency medicine physicians. In rural settings, odds were lower compared to urban settings (OR 0.50, 95% CI 0.29\u20130.88). In case of insufficient diuretic response, 64.6% favoured escalation via sequential nephron blockade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reported decision-making showed substantial variability regarding diuretic treatment monitoring and escalation strategies. Urinary sodium measurement was infrequently selected and may represent a potential target for future educational efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag161","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:45:48Z","timestamp":1780487148000},"source":"Crossref","is-referenced-by-count":0,"title":["Reported decision-making regarding diuretic use and urinary sodium monitoring in acute heart failure: a vignette-based survey in three European countries"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5501-6285","authenticated-orcid":false,"given":"Niclas","family":"Geldermann","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Luzerner Kantonsspital , Kantonsspital 37, Lucerne 6004 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Filidoro","sequence":"additional","affiliation":[{"name":"University of Lucerne, Faculty of Health Sciences and Medicine , Lucerne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Paul","sequence":"additional","affiliation":[{"name":"Heart Center, Luzerner Kantonsspital , Lucerne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Venturini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Luzerner Kantonsspital , Kantonsspital 37, Lucerne 6004 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"B\u00fcrgi","sequence":"additional","affiliation":[{"name":"Department of Quality Management, Luzerner Kantonsspital , Lucerne ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Christ","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Luzerner Kantonsspital , Kantonsspital 37, Lucerne 6004 ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2026062010013013400_xvag161-B1","author":"World Health Organization"},{"key":"2026062010013013400_xvag161-B2","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1136\/hrt.2003.025270","article-title":"Clinical epidemiology of heart failure","volume":"93","author":"Mosterd","year":"2007","journal-title":"Heart"},{"key":"2026062010013013400_xvag161-B3","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/S0140-6736(17)32520-5","article-title":"Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals","volume":"391","author":"Conrad","year":"2018","journal-title":"Lancet"},{"key":"2026062010013013400_xvag161-B4","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1002\/ejhf.483","article-title":"Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. 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