{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:52:10Z","timestamp":1765882330068,"version":"3.48.0"},"reference-count":61,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T00:00:00Z","timestamp":1712534400000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007405","name":"The Danish Heart Foundation","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004191","name":"Novo Nordisk","doi-asserted-by":"publisher","award":["NNF20SA0067242"],"award-info":[{"award-number":["NNF20SA0067242"]}],"id":[{"id":"10.13039\/501100004191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,22]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Acute heart failure (AHF) is a critical, costly condition with high mortality rates, affecting millions annually. Despite advances in cardiovascular care, AHF treatment lacks robust evidence. AHF commonly manifests with sudden heart failure symptoms such as pulmonary congestion, and the pathophysiology involves fluid overload. Initial treatment is based on intravenous diuretics typically, but the optimal combination of drugs remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will systematically review randomised controlled trials enrolling patients with AHF and volume overload undergoing in-hospital diuretic treatment. We aim to investigate any diuretic intervention. Our search strategy includes the following databases: Embase, Medline, Latin American and Caribbean Health Sciences Literature, Web of Science and the Cochrane Central Register of Controlled Trials. The primary outcome is all-cause mortality. Secondary outcomes are serious adverse events, hospital readmission and kidney failure. Study results reported at the most extended follow-up will be used for all outcomes. If appropriate, we will conduct meta-analysis, trial sequential analysis and network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>No ethics approval is required for this study. The results will be published in a peer-reviewed journal in this field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023463979.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081890","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T21:30:47Z","timestamp":1712611847000},"page":"e081890","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Combination of diuretics for acute heart failure: a protocol for a systematic review of randomised clinical trials with network meta-analysis and trial sequential analysis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0987-5047","authenticated-orcid":false,"given":"Nihal","family":"Nahiz","sequence":"first","affiliation":[{"name":"Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmin Dam","family":"Lukoschewitz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekim","family":"Seven","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"Olsen El Caidi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Dahlgaard","family":"Hove","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Amager Hvidovre University Hospital, Hvidovre, Denmark"},{"name":"Center of Functional Imaging and Research, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janus","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5511-4668","authenticated-orcid":false,"given":"Johannes","family":"Grand","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,4,8]]},"reference":[{"key":"2025121602484849000_14.4.e081890.1","doi-asserted-by":"crossref","unstructured":"Emara AN , Mansour NO , Elnaem MH , et al . Efficacy of Nondiuretic Pharmacotherapy for improving the treatment of congestion in patients with acute heart failure: a systematic review of randomised controlled trials. J Clin Med 2022;11. doi:10.3390\/jcm11113112","DOI":"10.3390\/jcm11113112"},{"key":"2025121602484849000_14.4.e081890.2","first-page":"2971","article-title":"Comparison of diuretic strategies in diuretic-resistant acute heart failure: a systematic review and network meta-analysis","volume":"25","author":"Orso","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025121602484849000_14.4.e081890.3","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1111\/aas.14130","article-title":"Vasodilators for acute heart failure-A protocol for a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis","volume":"66","author":"Grand","year":"2022","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025121602484849000_14.4.e081890.4","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1002\/ehf2.12677","article-title":"Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics: a systematic review of the literature","volume":"7","author":"Wierda","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2025121602484849000_14.4.e081890.5","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/anae.14038","article-title":"Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta-analysis of randomised controlled trials","volume":"73","author":"Ng","year":"2018","journal-title":"Anaesthesia"},{"key":"2025121602484849000_14.4.e081890.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2025121602484849000_14.4.e081890.7","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1002\/ejhf.1502","article-title":"Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency Department presentation and their relationship with patient management and outcomes","volume":"21","author":"Javaloyes","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.8","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/ejhf.890","article-title":"Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC heart failure long-term Registry","volume":"19","author":"Chioncel","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2013.09.002"},{"key":"2025121602484849000_14.4.e081890.10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.632208"},{"key":"2025121602484849000_14.4.e081890.11","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.72.2_Suppl.S40"},{"key":"2025121602484849000_14.4.e081890.12","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-103-1-1"},{"key":"2025121602484849000_14.4.e081890.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005419"},{"key":"2025121602484849000_14.4.e081890.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(20)31805-2"},{"key":"2025121602484849000_14.4.e081890.15","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.cardfail.2016.06.423","article-title":"Relevance of changes in serum creatinine during a heart failure trial of Decongestive strategies: insights from the DOSE trial","volume":"22","author":"Brisco","year":"2016","journal-title":"J Card Fail"},{"key":"2025121602484849000_14.4.e081890.16","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/ejhf.2385","article-title":"Natriuresis-guided therapy in acute heart failure: rationale and design of the pragmatic urinary sodium-based treatment algoritHm in acute heart failure (PUSH-AHF) trial","volume":"24","author":"Ter Maaten","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.17","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.462"},{"key":"2025121602484849000_14.4.e081890.18","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1007\/s00392-020-01598-w","article-title":"Higher doses of loop diuretics limit Uptitration of angiotensin-converting enzyme inhibitors in patients with heart failure and reduced ejection fraction","volume":"109","author":"ter Maaten","year":"2020","journal-title":"Clin Res Cardiol"},{"key":"2025121602484849000_14.4.e081890.19","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-305294"},{"key":"2025121602484849000_14.4.e081890.20","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1002\/ejhf.1796","article-title":"Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP heart failure long-term Registry","volume":"22","author":"Kapelios","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.21","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1369"},{"key":"2025121602484849000_14.4.e081890.22","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 medicine and the society of academic emergency medicine","volume":"17","author":"Mebazaa","year":"2015","journal-title":"European J of Heart Fail"},{"key":"2025121602484849000_14.4.e081890.23","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1002\/ejhf.1753","article-title":"Clinical importance of urinary sodium excretion in acute heart failure","volume":"22","author":"Damman","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.24","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1002\/ejhf.1307","article-title":"Rationale and design of the ADVOR (acetazolamide in decompensated heart failure with volume overload) trial","volume":"20","author":"Mullens","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2025121602484849000_14.4.e081890.25","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/AC.70.3.3080630","article-title":"Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload","volume":"70","author":"Verbrugge","year":"2015","journal-title":"Acta Cardiol"},{"key":"2025121602484849000_14.4.e081890.26","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in acute decompensated heart failure with volume overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N Engl J Med"},{"key":"2025121602484849000_14.4.e081890.27","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad341"},{"key":"2025121602484849000_14.4.e081890.28","first-page":"1794","article-title":"Comparing the sodium Excreting efficacy of furosemide and Indapamide combination against furosemide and Metolazone combination in congestive heart failure patients: A randomized control trial","volume":"69","author":"Salahudin","year":"2019","journal-title":"J Pak Med Assoc"},{"key":"2025121602484849000_14.4.e081890.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2019.09.012"},{"key":"2025121602484849000_14.4.e081890.30","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.71.2.146"},{"key":"2025121602484849000_14.4.e081890.31","doi-asserted-by":"publisher","DOI":"10.1007\/s10557-005-3350-2"},{"key":"2025121602484849000_14.4.e081890.32","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac689"},{"key":"2025121602484849000_14.4.e081890.33","doi-asserted-by":"publisher","DOI":"10.1111\/1755-5922.12109"},{"key":"2025121602484849000_14.4.e081890.34","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1002\/phar.1798","article-title":"Efficacy and safety of intravenous chlorothiazide versus oral Metolazone in patients with acute decompensated heart failure and loop diuretic resistance","volume":"36","author":"Shulenberger","year":"2016","journal-title":"Pharmacotherapy"},{"key":"2025121602484849000_14.4.e081890.35","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12082793","article-title":"Ultrafiltration versus diuretics on Prognostic cardiac and renal biomarkers in acute decompensated heart failure: A systematic review and meta-analysis","volume":"12","author":"Tay","year":"2023","journal-title":"J Clin Med"},{"key":"2025121602484849000_14.4.e081890.36","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s00059-017-4563-4","article-title":"Use of Tolvaptan vs. furosemide in older patients with heart failure: meta-analysis of randomized controlled trials","volume":"43","author":"Huang","year":"2018","journal-title":"Herz"},{"key":"2025121602484849000_14.4.e081890.37","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40256-013-0034-3","article-title":"Ultrafiltration versus intravenous diuretic therapy to treat acute heart failure: a systematic review","volume":"13","author":"Wen","year":"2013","journal-title":"Am J Cardiovasc Drugs"},{"key":"2025121602484849000_14.4.e081890.38","doi-asserted-by":"crossref","first-page":"e1163","DOI":"10.1097\/CCM.0000000000005174","article-title":"Simultaneous use of Hypertonic saline and IV furosemide for fluid overload: A systematic review and meta-analysis","volume":"49","author":"Liu","year":"2021","journal-title":"Crit Care Med"},{"key":"2025121602484849000_14.4.e081890.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2013.10.009"},{"key":"2025121602484849000_14.4.e081890.40","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s40256-020-00453-7","article-title":"Efficiency of Hypertonic saline in the management of decompensated heart failure: A systematic review and meta-analysis of clinical studies","volume":"21","author":"Covic","year":"2021","journal-title":"Am J Cardiovasc Drugs"},{"key":"2025121602484849000_14.4.e081890.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12933-022-01455-2","article-title":"Efficacy and safety of sodium-glucose cotransporter 2 inhibitors initiation in patients with acute heart failure, with and without type 2 diabetes: a systematic review and meta-analysis","volume":"21","author":"Salah","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"2025121602484849000_14.4.e081890.42","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10741-018-9727-7","article-title":"Continuous versus intermittent administration of furosemide in acute decompensated heart failure: a systematic review and meta-analysis","volume":"24","author":"Kuriyama","year":"2019","journal-title":"Heart Fail Rev"},{"key":"2025121602484849000_14.4.e081890.43","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.cardfail.2019.11.013","article-title":"Continuous infusion versus intermittent Boluses of furosemide in acute heart failure: a systematic review and meta-analysis","volume":"26","author":"Chan","year":"2020","journal-title":"J Card Fail"},{"key":"2025121602484849000_14.4.e081890.44","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/phar.2440","article-title":"A systematic review and meta-analysis of Metolazone compared to chlorothiazide for treatment of acute decompensated heart failure","volume":"40","author":"Steuber","year":"2020","journal-title":"Pharmacotherapy"},{"key":"2025121602484849000_14.4.e081890.45","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for systematic reviews of interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121602484849000_14.4.e081890.46","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"2025121602484849000_14.4.e081890.47","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-017-0315-7","article-title":"Trial sequential analysis in systematic reviews with meta-analysis","volume":"17","author":"Wetterslev","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2025121602484849000_14.4.e081890.48","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2025121602484849000_14.4.e081890.49","article-title":"Ultrafiltration for acute heart failure","volume":"1","author":"Srivastava","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121602484849000_14.4.e081890.50","unstructured":"ICH Harmonised guideline integrated Addendum to ICH E6(R1): guideline for good clinical practice ICH E6(R2) ICH consensus guideline. ICHGCP 2023;12. Available: https:\/\/ichgcp.net\/da\/home"},{"key":"2025121602484849000_14.4.e081890.51","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-021-01705-6","article-title":"\u201cBeneficial and harmful effects of antidepressants versus placebo, \u201cactive placebo\u201d, or no intervention for adults with major depressive disorder: a protocol for a systematic review of published and unpublished data with meta-analyses and trial sequential analyses\u201d","volume":"10","author":"Juul","year":"2021","journal-title":"Syst Rev"},{"key":"2025121602484849000_14.4.e081890.52","unstructured":"Cochrane Handbook for systematic reviews of interventions. 2022. Available: https:\/\/training.cochrane.org\/handbook\/current [Accessed 13 Jun 2022]."},{"key":"2025121602484849000_14.4.e081890.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2013.08.004"},{"key":"2025121602484849000_14.4.e081890.54","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2380"},{"key":"2025121602484849000_14.4.e081890.55","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025121602484849000_14.4.e081890.56","doi-asserted-by":"publisher","DOI":"10.2307\/2533446"},{"key":"2025121602484849000_14.4.e081890.57","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/31.1.140"},{"key":"2025121602484849000_14.4.e081890.58","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2288-14-120","article-title":"Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods","volume":"14","author":"Jakobsen","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"2025121602484849000_14.4.e081890.59","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780060325"},{"key":"2025121602484849000_14.4.e081890.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2015.09.002"},{"key":"2025121602484849000_14.4.e081890.61","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-018-0770-1","article-title":"Assessing Imprecision in Cochrane systematic reviews: a comparison of GRADE and trial sequential analysis","volume":"7","author":"Castellini","year":"2018","journal-title":"Syst Rev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-081890","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:48:59Z","timestamp":1765882139000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-081890"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":61,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,8]]},"published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1136\/bmjopen-2023-081890"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-081890","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2024,4]]}}}