2023
In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility
Ivey-Miranda J, Rao V, Cox Z, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner J, Collins S, Wilson F, Krumholz H, Testani J. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circulation Heart Failure 2023, 16: e010206. PMID: 36896716, PMCID: PMC10186250, DOI: 10.1161/circheartfailure.122.010206.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureDiuretic responseDiuretic dosingOral diureticsHeart failureMulticenter cohortHospital observationLower readmission ratesNet fluid balanceDays postdischargeReadmission ratesHospital readmissionUrine outputReadmission riskFluid statusFluid balanceHospital measuresDose selectionCohortProvider decisionsWeight changeReadmissionDiureticsPatientsEffect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure
Mentz R, Anstrom K, Eisenstein E, Sapp S, Greene S, Morgan S, Testani J, Harrington A, Sachdev V, Ketema F, Kim D, Desvigne-Nickens P, Pitt B, Velazquez E, Adams K, Bhatt K, DeWald T, Axsom K, Murthy S, Rich J, Testani J, Smith B, Vader J, McCulloch M, Skopicki H, Psotka M, Heroux A, Lala-Trindade A, Stevens G, Tang W, Lev Y, William P, Eberly A, Gottleib S, Haught W, Grafton G, Larned J, Tejwani L, Mody F, Krim S, Robinson M, Fang J, Adler A, Bell A, Banerjee D, Ruiz Duque E, Mizyed A, Rommel J, Arhinful J, Goyal P, Hall M, Hummel S, Shetty S, Haas D, Vilaro J, Alexy T, Herre J, Clark J, Ambrosy A, Gaglianello N, Ramasubbu K, Meadows J, Tabtabai S, Sherwood M, Hasni S, D'Urso M, Muneer B, Dunlap S, Davis W, Friedman D, Guglin M, Ferguson A, Abbate A, Smart F. Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure. JAMA 2023, 329: 214-223. PMID: 36648467, PMCID: PMC9857435, DOI: 10.1001/jama.2022.23924.Peer-Reviewed Original ResearchConceptsCause mortalityHeart failureTorsemide groupFurosemide groupTotal hospitalizationsCause hospitalizationEffects of torsemideDiuretic strategyPrespecified subgroupsSecondary outcomesEjection fractionMedian agePrimary outcomeHospitalizationMAIN OUTCOMEPatientsFurosemideMortalityMonthsTorsemidePrimary hypothesisSignificant differencesFinal dateOutcomesTrials
2021
Use of diuretics and outcomes in patients with type 2 diabetes: findings from the EMPA‐REG OUTCOME trial
Pellicori P, Fitchett D, Kosiborod MN, Ofstad AP, Seman L, Zinman B, Zwiener I, Wanner C, George J, Inzucchi SE, Testani JM, Cleland JGF. Use of diuretics and outcomes in patients with type 2 diabetes: findings from the EMPA‐REG OUTCOME trial. European Journal Of Heart Failure 2021, 23: 1085-1093. PMID: 34031968, PMCID: PMC11497224, DOI: 10.1002/ejhf.2220.Peer-Reviewed Original ResearchConceptsUse of LDDiagnosis of HFHeart failureLoop diureticsHF diagnosisEMPA-REG OUTCOME trialType 2 diabetes mellitusSigns of congestionCardiovascular eventsCardiovascular mortalityOutcome trialsDiabetes mellitusPatient subgroupsPatientsDiagnosisHigh rateOutcomesMellitusT2DMDiureticsSymptomsMortalityBaselineTrialsRisk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation
Ivey-Miranda JB, Maulion C, Farrero-Torres M, Griffin M, Posada-Martinez EL, Testani JM, Bellumkonda L. Risk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation. Journal Of Thoracic And Cardiovascular Surgery 2021, 165: 711-720. PMID: 34167814, DOI: 10.1016/j.jtcvs.2021.05.032.Peer-Reviewed Original ResearchConceptsHeart transplantMajor risk factorRisk factorsPosttransplantation mortalityHT recipientsMembrane oxygenationGood long-term prognosisSevere cardiogenic shockOrgan Sharing databaseLong-term prognosisExtracorporeal membrane oxygenationMinor risk factorsVentricular assist deviceCardiogenic shockHeart transplantationRecipient ageIndependent predictorsPrimary outcomeSharing databaseMechanical ventilationRisk stratificationUnited NetworkAdult candidatesECMOAbsence of recoveryElectronic health record alerts for acute kidney injury: multicenter, randomized clinical trial
Wilson FP, Martin M, Yamamoto Y, Partridge C, Moreira E, Arora T, Biswas A, Feldman H, Garg AX, Greenberg JH, Hinchcliff M, Latham S, Li F, Lin H, Mansour SG, Moledina DG, Palevsky PM, Parikh CR, Simonov M, Testani J, Ugwuowo U. Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial. The BMJ 2021, 372: m4786. PMID: 33461986, PMCID: PMC8034420, DOI: 10.1136/bmj.m4786.Peer-Reviewed Original ResearchConceptsAcute kidney injuryElectronic health record alertsKidney injuryPrimary outcomeMedical recordsYale New Haven Health SystemCare practicesGlobal Outcomes creatinine criteriaLarge tertiary care centerComposite of progressionDays of randomizationReceipt of dialysisPrespecified secondary outcomesTertiary care centerPatients' medical recordsSmall community hospitalNon-teaching hospitalsElectronic health recordsCreatinine criteriaUsual careSecondary outcomesAdult inpatientsKidney diseaseClinical centersWorse outcomes
2020
Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience
Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S, Raghavendra P, D'Ambrosi J, Riello R, Coca SG, Mahoney D, Jacoby D, Ahmad T, Chen M, Tang WHW, Turner J, Mullens W, Wilson FP, Testani JM. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience. JACC Heart Failure 2020, 8: 199-208. PMID: 32035891, PMCID: PMC7814403, DOI: 10.1016/j.jchf.2019.10.012.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureHypertonic saline administrationHypertonic saline therapyHypertonic salineSaline administrationSaline therapyDiuretic efficiencyUrine outputSerum sodiumWeight lossAcute decompensated heartDecompensated heart failureCohort of patientsTotal urine outputReal-world safetyU.S. academic medical centersAcademic medical centerLarge U.S. academic medical centerDiuretic doseCenter experienceHeart failureMetabolic derangementsPrimary analytic approachRespiratory statusClinical variablesAccess and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System
Thomas A, Papoutsidakis N, Spatz E, Testani J, Soucier R, Chou J, Ahmad T, Darr U, Hu X, Li F, Chen ME, Bellumkonda L, Sumathipala A, Jacoby D. Access and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System. Journal Of The American Heart Association 2020, 9: e014095. PMID: 31973610, PMCID: PMC7033886, DOI: 10.1161/jaha.119.014095.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedCardiomyopathy, HypertrophicCause of DeathConnecticutDelivery of Health Care, IntegratedFemaleHealthcare DisparitiesHeart Disease Risk FactorsHospitalizationHumansMaleMiddle AgedOutcome and Process Assessment, Health CareReferral and ConsultationRetrospective StudiesRisk AssessmentSocial ClassSocial Determinants of HealthTreatment OutcomeConceptsSpecialty careHCM patientsCare cohortHypertrophic cardiomyopathyYale New Haven Health SystemLarge integrated health systemHealth systemBackground Hypertrophic cardiomyopathyRetrospective cohort studySocioeconomic statusPatients' socioeconomic statusHigher socioeconomic status groupsHypertrophic cardiomyopathy patientsIntegrated health systemSpecialty care accessSocioeconomic status groupsMedical insurance providersCardiomyopathy clinicCause deathLSES patientsCause hospitalizationCause mortalityNoncardiac causesCohort studySecondary outcomes
2019
Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial
Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial. JACC Heart Failure 2019, 8: 157-168. PMID: 31838029, PMCID: PMC7058489, DOI: 10.1016/j.jchf.2019.09.012.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedChlorothiazideDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Therapy, CombinationFemaleFollow-Up StudiesFurosemideHeart FailureHumansInfusions, IntravenousMaleMetolazoneMiddle AgedProspective StudiesRetrospective StudiesTolvaptanTreatment OutcomeConceptsAcute heart failureLoop diuretic resistanceDiuretic resistanceHigh-dose loop diuretic therapyLoop diuretic therapyDouble-blinded trialInfusion of furosemideCombination diureticsDiuretic strategyDiuretic therapyOral metolazoneTolvaptan therapyDiuretic efficacyHeart failurePrimary outcomePatientsLimited evidenceWeight lossTherapyChlorothiazideMetolazoneTolvaptanDiureticsInfusionCohortTreating Heart Failure With Antihyperglycemic Medications: Is Now the Right Time?
Testani JM, Inzucchi SE, Voors AA. Treating Heart Failure With Antihyperglycemic Medications: Is Now the Right Time? Circulation 2019, 139: 2383-2385. PMID: 31107618, DOI: 10.1161/circulationaha.119.038854.Commentaries, Editorials and LettersBiomarkersBlood GlucoseDiabetes Mellitus, Type 2Disease ProgressionEvidence-Based MedicineGlucagon-Like Peptide-1 ReceptorHeart FailureHospitalizationHumansIncretinsProtective FactorsRandomized Controlled Trials as TopicRisk AssessmentRisk FactorsSodium-Glucose Transporter 2 InhibitorsTreatment Outcome
2018
Enhancing the prediction of acute kidney injury risk after percutaneous coronary intervention using machine learning techniques: A retrospective cohort study
Huang C, Murugiah K, Mahajan S, Li SX, Dhruva SS, Haimovich JS, Wang Y, Schulz WL, Testani JM, Wilson FP, Mena CI, Masoudi FA, Rumsfeld JS, Spertus JA, Mortazavi BJ, Krumholz HM. Enhancing the prediction of acute kidney injury risk after percutaneous coronary intervention using machine learning techniques: A retrospective cohort study. PLOS Medicine 2018, 15: e1002703. PMID: 30481186, PMCID: PMC6258473, DOI: 10.1371/journal.pmed.1002703.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedClinical Decision-MakingData MiningDecision Support TechniquesFemaleHumansMachine LearningMaleMiddle AgedPercutaneous Coronary InterventionProtective FactorsRegistriesReproducibility of ResultsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsPercutaneous coronary interventionNational Cardiovascular Data RegistryRisk prediction modelAKI eventsAKI riskCoronary interventionAKI modelMean ageCardiology-National Cardiovascular Data RegistryAcute kidney injury riskAKI risk predictionRetrospective cohort studyIdentification of patientsCandidate variablesAvailable candidate variablesCohort studyPCI proceduresPoint of careBrier scoreAmerican CollegeData registryPatientsCalibration slopeInjury riskSame cohortOutcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis
Brisco‐Bacik M, Maaten J, Houser SR, Vedage NA, Rao V, Ahmad T, Wilson FP, Testani JM. Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis. Journal Of The American Heart Association 2018, 7: e009149. PMID: 30371181, PMCID: PMC6222930, DOI: 10.1161/jaha.118.009149.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedCause of DeathDose-Response Relationship, DrugFemaleFollow-Up StudiesGuideline AdherenceHeart FailureHumansInjections, IntravenousMaleMetolazonePropensity ScoreRetrospective StudiesSodium Chloride Symporter InhibitorsSodium Potassium Chloride Symporter InhibitorsStroke VolumeSurvival RateTreatment OutcomeUnited StatesConceptsHigh-dose loop diureticsAcute decompensated heart failureDecompensated heart failureLoop diureticsRenal functionPropensity adjustmentHeart failureCommon electronic medical recordIntravenous loop diureticsLoop diuretic dosePropensity-adjusted analysisThiazide-type diureticsControl trial dataElectronic medical recordsDiuretic doseDiuretic strategyCause mortalityAdverse eventsBaseline characteristicsSecondary outcomesThiazide diureticsResults PatientsDischarge diagnosisMedical recordsDiureticsPerturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT
Grodin JL, Testani JM, Pandey A, Sambandam K, Drazner MH, Fang JC, Tang WHW. Perturbations in serum chloride homeostasis in heart failure with preserved ejection fraction: insights from TOPCAT. European Journal Of Heart Failure 2018, 20: 1436-1443. PMID: 29893446, DOI: 10.1002/ejhf.1229.Peer-Reviewed Original ResearchConceptsSerum chloride levelsLoop diuretic useHeart failureSerum chlorideCause deathDiuretic useEjection fractionMultivariable Cox proportional hazards modelsCardiac Function Heart FailureCox proportional hazards modelAldosterone Antagonist TrialHeart failure hospitalizationPrimary composite endpointLower serum chlorideProportional hazards modelSerum chloride concentrationChloride levelsSpironolactone useCardiovascular deathFailure hospitalizationMultivariable adjustmentComposite endpointLoop diureticsClinical outcomesHazards modelOlder drugs with infantile evidence: the illustrative example of loop diuretics
Bikdeli B, Testani JM, Ross JS, Krumholz HM. Older drugs with infantile evidence: the illustrative example of loop diuretics. European Heart Journal - Quality Of Care And Clinical Outcomes 2018, 4: 232-234. PMID: 29617967, PMCID: PMC6030914, DOI: 10.1093/ehjqcco/qcy012.Peer-Reviewed Case Reports and Technical NotesWorsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury
Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH, Felker GM, Hernandez AF, O'Connor CM, Sabbisetti VS, Bonventre JV, Wilson FP, Coca SG, Testani JM. Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury. Circulation 2018, 137: 2016-2028. PMID: 29352071, PMCID: PMC6066176, DOI: 10.1161/circulationaha.117.030112.Peer-Reviewed Original ResearchMeSH KeywordsAcetylglucosaminidaseAcute DiseaseAcute Kidney InjuryAgedAged, 80 and overBiomarkersCreatinineCystatin CDiuresisFemaleGlomerular Filtration RateHeart FailureHepatitis A Virus Cellular Receptor 1HumansKidneyLipocalin-2MaleMiddle AgedSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeUnited StatesConceptsKidney injury molecule-1Neutrophil gelatinase-associated lipocalinInjury molecule-1Acute heart failureGelatinase-associated lipocalinRenal tubular injuryTubular injury biomarkersAggressive diuresisROSE-AHF trialsTubular injuryInjury biomarkersRenal functionHeart failureMolecule-1D-glucosaminidaseHigh-dose loop diuretic therapyAcute heart failure treatmentKidney tubular injuryLoop diuretic therapyAcute kidney injuryGlomerular filtration rateHeart failure treatmentDiuretic therapyFurosemide equivalentsKidney injury
2017
A Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure
Soufer A, Riello RJ, Desai NR, Testani JM, Ahmad T. A Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure. Progress In Cardiovascular Diseases 2017, 60: 237-248. PMID: 28826671, DOI: 10.1016/j.pcad.2017.08.004.Commentaries, Editorials and LettersConceptsHeart failureClinic visitsPost-discharge servicesTransitions of carePatient-centered fashionHospital quality measuresHF patientsHF readmissionMulti-disciplinary servicesSymptom burdenDischarge servicesOutpatient settingCare deliveryHealthcare expendituresHospital systemPatientsVisitsCareReadmissionAdmissionFailureInpatientsCliniciansImportant roleAn exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial
Hanberg JS, Tang WH, Wilson FP, Coca SG, Ahmad T, Brisco MA, Testani JM. An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial. International Journal Of Cardiology 2017, 241: 277-282. PMID: 28392080, PMCID: PMC5471358, DOI: 10.1016/j.ijcard.2017.03.114.Peer-Reviewed Original ResearchConceptsHigh-dose loop diureticsDiuretic doseAggressive decongestionDose trialFluid outputLoop diureticsHigh-dose loop diuretic therapyDose-related adverse effectsAdverse effectsLoop diuretic doseLoop diuretic therapyHeart failure patientsNet fluid balanceNet fluid outputRate of deathEmergency department (ED) visitationPotential beneficial effectsHypothesis-generating observationsEffective decongestionDiuretic therapyFailure patientsAdverse outcomesDecongestive effectImproved outcomesFluid balance
2016
Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF)
Grodin JL, Sun JL, Anstrom KJ, Chen HH, Starling RC, Testani JM, Tang WH. Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). The American Journal Of Cardiology 2016, 119: 78-83. PMID: 27816115, PMCID: PMC5161696, DOI: 10.1016/j.amjcard.2016.09.014.Peer-Reviewed Original ResearchConceptsAcute heart failureSerum Cl levelsHeart failureClinical outcomesDiuretic responseAcute heart failure trialsRenal Optimization Strategies EvaluationShort-term clinical responseCumulative sodium excretionLoop diuretic doseHeart Failure TrialLong-term mortalitySerum chloride levelsCystatin C changesDiuretic dosePostdischarge outcomesSodium excretionCl levelsClinical responseRenal functionDiuretic efficiencyFailure TrialAdditional adjustmentCystatin CTherapeutic implicationsDifferent diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance
Palazzuoli A, Testani JM, Ruocco G, Pellegrini M, Ronco C, Nuti R. Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance. International Journal Of Cardiology 2016, 224: 213-219. PMID: 27657476, DOI: 10.1016/j.ijcard.2016.09.005.Peer-Reviewed Original ResearchConceptsLower diuretic efficiencyChronic kidney diseaseDiuretic efficiencyAdverse eventsDose administrationAcute decompensated heart failureDecompensated heart failureAdverse event ratesDiuretic doseWRF occurrenceRenal dysfunctionClinical characteristicsRenal functionHeart failureHD patientsMultivariable analysisClinical statusPrognostic significanceAdverse outcomesContinuous administrationKidney diseaseDE patientsLD patientsBest modalityPatientsHypochloremia and Diuretic Resistance in Heart Failure
Hanberg JS, Rao V, Maaten J, Laur O, Brisco MA, Wilson F, Grodin JL, Assefa M, Broughton J, Planavsky NJ, Ahmad T, Bellumkonda L, Tang WH, Parikh CR, Testani JM. Hypochloremia and Diuretic Resistance in Heart Failure. Circulation Heart Failure 2016, 9: e003180. PMID: 27507113, PMCID: PMC4988527, DOI: 10.1161/circheartfailure.116.003180.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersChloridesConnecticutCross-Sectional StudiesDown-RegulationDrug ResistanceFemaleFurosemideHeart FailureHumansKidneyMaleMiddle AgedOdds RatioPilot ProjectsProspective StudiesReninRisk FactorsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeConceptsDiuretic resistanceHeart failureCare centerSerum chloridePro-B-type natriuretic peptideChloride supplementationRenal free water excretionB-type natriuretic peptidePoor diuretic responsePlasma renin activityPlasma renin concentrationHeart failure cohortFree water excretionRecent epidemiological studiesBasic science evidenceBlood urea nitrogenSerum chloride levelsFurosemide equivalentsNeurohormonal activationRenin activityRenin concentrationCreatinine ratioLoop diureticsDiuretic responseSerum sodiumHypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure
Ter Maaten JM, Damman K, Hanberg JS, Givertz MM, Metra M, O'Connor CM, Teerlink JR, Ponikowski P, Cotter G, Davison B, Cleland JG, Bloomfield DM, Hillege HL, van Veldhuisen DJ, Voors AA, Testani JM. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circulation Heart Failure 2016, 9: e003109. PMID: 27507112, DOI: 10.1161/circheartfailure.116.003109.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overBiomarkersChloridesDisease ProgressionDiureticsDown-RegulationDrug ResistanceFemaleHeart FailureHospitalizationHumansKaplan-Meier EstimateLinear ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRisk FactorsTime FactorsTreatment OutcomeXanthinesConceptsAcute heart failureMEq/L.Heart failureDay 14Serum chloridePoor diuretic responseHours of admissionLower serum chlorideBlood urea nitrogenSerum chloride levelsAHF therapiesDiuretic resistancePROTECT trialNeurohormonal activationMultivariable adjustmentRenal functionHospital admissionMultivariable analysisDiuretic responseDiuretic responsivenessDiuretic targetChloride levelsUrea nitrogenHypochloremiaChloride homeostasis