{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T23:38:17Z","timestamp":1771544297663,"version":"3.50.1"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n            <jats:title>Background and importance<\/jats:title>\n            <jats:p>Acute heart failure (AHF) is one of the main causes of unplanned hospitalization in patients &gt;65\u2009years of age and is associated with adverse outcomes in this population. Observational studies suggest that intravenous diuretic therapy given in the first hour of presentation for AHF was associated with favorable outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>To study the short-term prognostic associations of the timing of intravenous diuretic therapy in patients admitted to the emergency department (ED) for acute AHF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design, settings and participants<\/jats:title>\n            <jats:p>Patients treated in the ED with intravenous diuretics were selected from the Estratifica\u00e7\u00e3o de Doentes com InsuFIci\u00eancia Card\u00edaca Aguda (EDIFICA) registry, a prospective study including AHF hospitalized patients. Early and non-early furosemide treatment groups were considered using the 1-h cutoff: door-to-furosemide \u22641\u2009h and &gt;1\u2009h.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcomes measure and analysis<\/jats:title>\n            <jats:p>Primary outcomes were a composite of heart failure re-hospitalizations or cardiovascular death at 30- and 90-days.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main results<\/jats:title>\n            <jats:p>Four-hundred ninety-three patients were included in the analysis. The median (interquartile range) door-to-furosemide time was 85 (41\u2013220) min, and 210 (43%) patients had diuretics in the first hour. Patients in the \u22641\u2009h group had higher evaluation priority according to the Manchester Triage System, presented more often with acute pulmonary edema, warm-wet clinical profile, higher blood pressure, and signs of left-side heart failure, while &gt;1\u2009h group had higher Get With the Guidelines-heart failure risk score, more frequent signs of right-side heart failure, higher circulating B-type natriuretic peptides and lower albumin. Door-to-furosemide \u2264\u20091\u2009h was independently associated with lower 30-day heart failure hospitalizations and composite of heart failure hospitalizations or cardiovascular death (adjusted analysis Heart Failure Hospitalizations: odds ratios (OR) 3.65; 95% confidence interval (CI), 1.22\u201310.9; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.020; heart failure hospitalizations or cardiovascular death: OR 3.15; 95% CI, 1.49\u20136.64; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009&lt;\u20090.001). These independent associations lost significance at 90 days.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Door-to-furosemide \u22641\u2009h was associated with a lower short-term risk of heart failure hospitalizations or cardiovascular death in AHF patients. Our findings add to the existing evidence that early identification and intravenous diuretic therapy of AHF patients may improve outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/mej.0000000000001006","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T12:28:18Z","timestamp":1675427298000},"page":"85-90","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":19,"title":["Door-to-furosemide time and clinical outcomes in acute heart failure"],"prefix":"10.1097","volume":"30","author":[{"given":"Pedro","family":"Marques","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"},{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]},{"given":"Maria T.","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Francisco","family":"Vasques-N\u00f3voa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"},{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]},{"given":"Jo\u00e3o P.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"},{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurith\u00e9matique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France"}]},{"given":"Ana L.","family":"Jardim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Rita","family":"Gouveia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Bruno","family":"Besteiro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Joana T.","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Filipa","family":"Gomes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"}]},{"given":"Adelino","family":"Leite-Moreira","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]},{"given":"Paulo","family":"Bettencourt","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"},{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]},{"given":"Jorge","family":"Almeida","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"},{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]},{"given":"Fernando","family":"Fri\u00f5es","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o"},{"name":"Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal"}]}],"member":"276","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"R1-20250801","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41572-020-0151-7","article-title":"Acute heart failure.","volume":"6","author":"Arrigo","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"R2-20250801","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1002\/ejhf.289","article-title":"Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency 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heart failure therapy and outcomes among older patients hospitalized for acute decompensated heart failure: findings from the acute decompensated heart failure registry emergency module (ADHERE-EM).","volume":"166","author":"Wong","year":"2013","journal-title":"Am Heart J"}],"container-title":["European Journal of Emergency 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