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 variables
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 lossTherapyChlorothiazideMetolazoneTolvaptanDiureticsInfusionCohort
2018
Outcomes 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 recordsDiureticsOlder 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 NotesDose-Response Relationship, DrugHeart FailureHumansSodium Potassium Chloride Symporter InhibitorsTreatment Outcome
2017
An 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 balanceRenal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure
Maaten J, Rao VS, Hanberg JS, Wilson F, Bellumkonda L, Assefa M, Broughton J, D'Ambrosi J, Tang W, Damman K, Voors AA, Ellison DH, Testani JM. Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure. European Journal Of Heart Failure 2017, 19: 1014-1022. PMID: 28105769, PMCID: PMC6231236, DOI: 10.1002/ejhf.757.Peer-Reviewed Original ResearchConceptsAcute heart failureLoop diuretic resistanceRenal tubular responseDiuretic resistanceDiuretic responseRenal tubulesAHF patientsHeart failureLoop diureticsTubular responseRenal tubular resistanceBumetanide doseEffective decongestionIntravenous bumetanidePoor outcomeUrine collectionTubular resistanceSum of defectsPatient variabilityUrea clearancePatientsCommon barriersDoseClearanceDiuretics
2016
Different 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 modalityPatientsRelevance of Changes in Serum Creatinine During a Heart Failure Trial of Decongestive Strategies: Insights From the DOSE Trial
Brisco MA, Zile MR, Hanberg JS, Wilson FP, Parikh CR, Coca SG, Tang WH, Testani JM. Relevance of Changes in Serum Creatinine During a Heart Failure Trial of Decongestive Strategies: Insights From the DOSE Trial. Journal Of Cardiac Failure 2016, 22: 753-760. PMID: 27374839, PMCID: PMC5435117, DOI: 10.1016/j.cardfail.2016.06.423.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersCause of DeathCreatinineDisease ProgressionDisease-Free SurvivalDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleFemaleFurosemideGlomerular Filtration RateHeart FailureHumansInfusions, IntravenousKidney Function TestsMaleMiddle AgedPrognosisSurvival RateTreatment OutcomeConceptsStable renal functionRenal functionComposite endpointDecongestive strategiesSerum creatinineDose trialAdverse outcomesClinical trialsSurrogate endpointsDiuretic Optimization Strategies Evaluation (DOSE) trialHeart failure clinical trialsHeart Failure TrialPoor prognostic signCoprimary endpointsComposite outcomeDecongestive therapyFailure TrialPrognostic signEmergency roomImproved outcomesLower riskCreatinineEndpointTrialsAbsence of risk
2015
Diuretic response in acute heart failure—an analysis from ASCEND-HF
Maaten J, Dunning AM, Valente MA, Damman K, Ezekowitz JA, Califf RM, Starling RC, van der Meer P, O'Connor CM, Schulte PJ, Testani JM, Hernandez AF, Tang WH, Voors AA. Diuretic response in acute heart failure—an analysis from ASCEND-HF. American Heart Journal 2015, 170: 313-321.e4. PMID: 26299229, DOI: 10.1016/j.ahj.2015.05.003.Peer-Reviewed Original ResearchConceptsAcute heart failureLow urine outputLower blood pressureDiuretic responseHospital admissionUrine outputBlood pressureHeart failurePoor baseline renal functionGood diuretic responseHeart failure rehospitalizationPoor diuretic responseBaseline renal functionASCEND-HF trialRisk of deathLong-term useDiuretic unresponsivenessNesiritide treatmentCause mortalityRenal impairmentPoor respondersRenal functionClinical predictorsLoop diureticsASCEND-HFSubstantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment
Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, Coca SG, Tang WH. Substantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment. The American Journal Of Medicine 2015, 128: 776-783.e4. PMID: 25595470, PMCID: PMC4475432, DOI: 10.1016/j.amjmed.2014.12.020.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAge FactorsAgedAged, 80 and overBody FluidsCohort StudiesDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleFemaleFollow-Up StudiesHeart FailureHumansInfusions, IntravenousMaleMiddle AgedRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexSex FactorsStatistics, NonparametricSurvival RateTreatment OutcomeWeight LossConceptsAcute decompensated heart failureDecompensated heart failureDiuretic Optimization Strategies EvaluationHeart failureWeight lossAcute Decompensated Heart Failure (CARRESS-HF) trialPatient careDecompensated Heart Failure (ASCEND-HF) trialPulmonary Artery Catheterization EffectivenessAcute decompensated heartHeart Failure TrialCongestive heart failureHeart failure researchBaseline characteristicsDiuretic responseFailure TrialLimits of agreementFailure treatmentFluid balanceDecompensated heartNet fluidGreater fluidPatientsCareTreatment
2013
Loop Diuretic Efficiency
Testani JM, Brisco MA, Turner JM, Spatz ES, Bellumkonda L, Parikh CR, Tang WH. Loop Diuretic Efficiency. Circulation Heart Failure 2013, 7: 261-270. PMID: 24379278, PMCID: PMC4386906, DOI: 10.1161/circheartfailure.113.000895.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseCause of DeathDiuresisDose-Response Relationship, DrugFemaleFollow-Up StudiesGlomerular Filtration RateHeart FailureHospital MortalityHumansInjections, IntravenousMaleMiddle AgedPatient DischargePennsylvaniaPrognosisProspective StudiesSodium Potassium Chloride Symporter InhibitorsSurvival RateTreatment OutcomeConceptsLower diuretic efficiencyDiuretic efficiencyNet fluid outputDiuretic doseHeart failureFluid outputBaseline characteristicsPoor long-term outcomesDecompensated heart failureDistinct prognostic informationDose of diureticsPrimary discharge diagnosisCongestive heart failureTraditional prognostic factorsLong-term outcomesCatheterization variablesFurosemide equivalentsDiuretic therapyRenal functionWorsened survivalPrognostic factorsUrine outputDecongestive therapyDischarge diagnosisConsecutive admissions
2011
Interaction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure
Testani JM, Cappola TP, Brensinger CM, Shannon RP, Kimmel SE. Interaction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure. Journal Of The American College Of Cardiology 2011, 58: 375-382. PMID: 21757114, PMCID: PMC3980479, DOI: 10.1016/j.jacc.2011.01.052.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood Urea NitrogenDose-Response Relationship, DrugFemaleHeart FailureHumansMaleMiddle AgedSodium Potassium Chloride Symporter InhibitorsTreatment OutcomeConceptsHigh-dose loop diureticsBlood urea nitrogenLoop diureticsBUN levelsNeurohormonal activationBaseline characteristicsHeart failureNormal BUN levelChronic heart failureRisk of deathBlood urea nitrogen concentrationElevated BUN levelsCongestive symptomsOverall cohortWorsened survivalImproved survivalPrimary outcomeAdverse outcomesUrea nitrogen concentrationDiureticsUrea nitrogenBUN concentrationPatientsMortalitySurvival