What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (n=220). Intervention: High diuretic resistance (DR) risk (BAN-ADHF score >12) vs. Low DR risk (BAN-ADHF score ≤12). Primary outcome: 30-day mortality (p=0.035).

What type of study is this?

This is a RCT study (also classified as: Observational).

August 26, 2025European Journal of Heart FailureOpen Access

Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post‐hoc analysis of the CLOROTIC trial

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Key result

High diuretic resistance risk in ADHF is linked to ~4-fold higher 30-day mortality.

P=0.035
n=220

Why the study?

Does hydrochlorothiazide improve weight loss and dyspnoea in acute decompensated heart failure patients stratified by diuretic resistance risk?

Key Points

High diuretic resistance was associated with worse outcomes, including increased mortality and lower fluid loss in patients.
The BAN-ADHF score effectively identified patients with low diuretic efficiency, showing an area under the curve of 0.81.
The treatment effect of hydrochlorothiazide on weight change was consistent across diuretic resistance levels, with no significant interaction effect.
Improvement in dyspnoea was significantly lower in patients with high diuretic resistance, indicating a modified response to hydrochlorothiazide.

Study Design

Type

Cohort (n=220)

Structured PICO

Does hydrochlorothiazide improve weight loss and dyspnoea in acute decompensated heart failure patients stratified by diuretic resistance risk?

Population

220 participants (mean age 83 years, 49.1% female) with acute decompensated heart failure from the CLOROTIC trial.

Exposure

Hydrochlorothiazide (HCTZ) added to intravenous furosemide

Comparator

Placebo added to intravenous furosemide

Outcome

Weight change and area under the curve (AUC) of dyspnoea visual analogue scale (VAS) at 72/96 h, fluid loss at 72 h, and 30/90-day mortalitysurrogate

Main Result

Absolute Event Rate: 11.1% vs 2.4%

p-value: p=0.035

Discussion

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Implication

The BAN-ADHF score effectively identifies diuretic resistance in ADHF, and while HCTZ improves weight loss regardless of DR risk, its benefit on dyspnoea is attenuated in high-risk patients.

Cite This Study

Pandey et al. (2025) conducted a cohort in Acute decompensated heart failure (n=220). High diuretic resistance (DR) risk (BAN-ADHF score >12) vs. Low DR risk (BAN-ADHF score ≤12) was evaluated on 30-day mortality (p=0.035). High diuretic resistance risk in acute decompensated heart failure was associated with higher 30-day mortality (11.1% vs. 2.4%, p=0.035) and attenuated dyspnoea improvement with hydrochlorothiazide.

synapsesocial.com/papers/68af63e9ad7bf08b1eae4631 https://doi.org/10.1002/ejhf.70002

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Implication

The BAN-ADHF score effectively identifies diuretic resistance in ADHF, and while HCTZ improves weight loss regardless of DR risk, its benefit on dyspnoea is attenuated in high-risk patients.

Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post‐hoc analysis of the CLOROTIC trial

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Diuretic resistance and the efficacy of hydrochlorothiazide in acute decompensated heart failure: A post‐hoc analysis of the CLOROTIC trial

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Also Consider