{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:37:06Z","timestamp":1791247026287,"version":"4.1.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,7,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Mortality is increased following a hospitalization for decompensated heart failure (\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              ), during which diuretics are usually intensified. It is unclear how risk is affected after outpatient intensification of diuretic therapy for\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From nationwide administrative registers, we identified all Danish patients who were diagnosed with\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              from 2001 to 2016 and received angiotensin\u2010converting enzyme inhibitor\/angiotensin receptor blocker and \u03b2 blocker within 120\u00a0days. Subsequent follow\u2010up tracked progressive events of diuretic intensification and\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              hospitalization. Intensification events were defined as new addition or doubling of loop diuretic or addition of thiazide to loop diuretic. These events were included in multivariable Cox regression models, calculating 1\u2010year mortality hazard after each year since inclusion. Patients with an intensification event or hospitalization were risk set matched to 2 nonworsened\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              controls and absolute 1\u2010year mortality risks were calculated using Kaplan\u2010Meier estimates. We included 74\u00a0990 patients, their median age was 71 years, and 36% were women. Intensification events were associated with significantly increased mortality at all times during follow\u2010up. One\u2010year mortality was 18.0% after an intensification event, 22.6% after\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              hospitalization, and 10.4% for matched controls with neither. In a multivariable Cox model adjusted for age, sex, ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease, and diabetes mellitus, the hazard ratio for 1\u2010year death after an intensification event was 1.75 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.66\u20131.85), and it was 2.28 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 2.16\u20132.41) after\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              hospitalization.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In a nationwide cohort of patients with\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              , outpatient intensification events were associated with almost 2\u2010fold risk of mortality during the next year. Although\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              hospitalization was associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve\n              <jats:styled-content style=\"fixed-case\">HF<\/jats:styled-content>\n              outcomes.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.016010","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T09:05:03Z","timestamp":1594717503000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["One\u2010Year Mortality After Intensification of Outpatient Diuretic Therapy"],"prefix":"10.1161","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9549-7707","authenticated-orcid":false,"given":"Christian","family":"Madelaire","sequence":"first","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"The Heart Centre Rigshospitalet University of Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne Warner","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren Lund","family":"Kristensen","sequence":"additional","affiliation":[{"name":"The Heart Centre Rigshospitalet University of Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"The Heart Centre Rigshospitalet University of Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Andersen","sequence":"additional","affiliation":[{"name":"Danish Heart Foundation Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor","family":"Biering\u2010S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Andersson","sequence":"additional","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"},{"name":"Section of Cardiology Department of Medicine Boston Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Clinical Research Nordsjaellands Hospital Hilleroed Denmark"},{"name":"Department of Cardiology Aalborg University Hospital Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Gislason","sequence":"additional","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"},{"name":"Danish Heart Foundation Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Schou","sequence":"additional","affiliation":[{"name":"Department of Cardiology Herlev and Gentofte University Hospital Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.696906"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.01.041"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020729"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.12.072"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2008.01.015"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.02.020"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S91125"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2008.05.006"},{"key":"e_1_3_1_11_2","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Development Core Team","year":"2008","unstructured":"R Development Core Team . 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