Heart failure & cardiomyopathiesCross-sectional study
Reported decision-making regarding diuretic use and urinary sodium monitoring in acute heart failure: a vignette-based survey in three European countries
- multinational, case-based cross-sectional survey
- standardized hypothetical clinical vignettes
- multivariable binomial logistic regression
Authors' conclusion
Reported decision-making showed substantial variability regarding diuretic treatment monitoring and escalation strategies. Urinary sodium measurement was infrequently selected and may represent a potential target for future educational efforts.
Study context
- Population
- Clinicians involved in heart failure management in Switzerland, Germany, and Austriaclinicians participated
- Participants
- 787 clinicians
- Exposure
- factors associated with guideline-concordant initial diuretic dosing and use of urinary sodium measurement
Main finding
As reported in the abstract
Guideline-concordant initial loop diuretic dosing
diuretic-naive patients
53.4%
patients receiving chronic diuretic therapy
87.7%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Urinary sodium measurement (multivariable regression) — Switzerland vs Germany | 3.36 (2.09–5.42) | |
| Urinary sodium measurement (multivariable regression) — Austria vs Germany | 2.64 (1.12–6.22) | |
| Urinary sodium measurement (multivariable regression) — General practitioners/internal medicine physicians vs emergency medicine physicians | 3.52 (1.83–6.79) | |
| Urinary sodium measurement (multivariable regression) — resident physicians vs emergency medicine physicians | 2.60 (1.50–4.51) | |
| Urinary sodium measurement (multivariable regression) — prehospital emergency physicians vs emergency medicine physicians | 2.08 (1.08–4.03) | |
| Urinary sodium measurement (multivariable regression) — rural settings vs urban settings · odds lower in rural settings | 0.50 (0.29–0.88) | |
| 0.10.31310Odds ratio (log scale) |
Treatment monitoring using urinary sodium measurement
- reported by
- 16.9%
Escalation via sequential nephron blockade in case of insufficient diuretic response
- favoured
- 64.6%
Original publication
Reported decision-making regarding diuretic use and urinary sodium monitoring in acute heart failure: a vignette-based survey in three European countries. ESC Heart Fail. Published 4 June 2026. doi:10.1093/eschf/xvag161
Summarised from the published abstract; every number is checked against it