External validation of the BAN‐ADHF diuretic‐resistance score in the DAPA‐RESIST clinical trial

Diuretic resistance in worsening heart failure (HF) is associated with poorer outcomes and, although common, can be challenging to identify. The recently developed BAN-ADHF score can potentially identify patients with worsening HF at risk of diuretic resistance. We externally validated the BAN-ADHF diuretic-resistance score in a multicentre randomized trial comparing adjunctive dapagliflozin to metolazone in patients with HF and diuretic resistance. We calculated a seven-variable modified BAN-ADHF score at baseline and dichotomised patients by the median BAN-ADHF score (8). We assessed loop diuretic efficiency (kg weight change per 40-mg furosemide) and decongestion (weight, eight-zone lung ultrasound B-lines, clinical congestion score) over 96 h. A baseline score ≥8 identified lower loop diuretic efficiency (pooled difference -0.12 kg/40 mg, 95% CI -0.18 to -0.06; p < 0.001) despite similar congestion markers at baseline. The BAN-ADHF score may be useful clinically to identify patients at risk of diminished response to diuretics.