{"id":"4594c10f7bc6","type":"article","url":"https://hartvaat.nl/2026/05/05/grote-variatie-in-diureticabeleid-en-zeldzame-natriummeting-bij-acuut-hartfalen/","title":"Grote variatie in diureticabeleid en zeldzame natriummeting bij acuut hartfalen","title_en":"Reported decision-making regarding diuretic use and urinary sodium monitoring in acute heart failure: a vignette-based survey in three European countries.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag161","source_url":"https://doi.org/10.1093/eschf/xvag161","authors":["Niclas Geldermann","Noemi Filidoro","Matthias Paul","Stefan Venturini","Andrea Bürgi","Michael Christ"],"significance":5,"published":"2026-07-31","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"A multinational vignette survey of 787 clinicians in Switzerland, Germany, and Austria reveals substantial variability in diuretic management and monitoring for acute heart failure. Only 16.9% reported routinely using urinary sodium measurement, while 64.6% preferred sequential nephron blockade for inadequate diuretic response. These findings highlight a significant gap between guideline recommendations and real-world practice. Targeted educational initiatives may be needed to standardize monitoring and optimize acute heart failure care.","created":"2026-07-24T00:59:55Z","updated":"2026-08-10T10:37:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een multinational steekproefonderzoek onder 787 klinisch werkers in Zwitserland, Duitsland en Oostenrijk toont aan dat het diureticabeleid bij acuut hartfalen sterk verschilt. Alleen 16,9% van de respondenten gaf aan regelmatig urine-natrium te meten voor monitoring, terwijl 64,6% bij onvoldoende respons kiest voor sequentiële nefronblokkade. Deze variatie en het lage gebruik van natriummeting vormen een duidelijk knelpunt voor de richtlijnconforme zorg. De resultaten benadrukken de behoefte aan gerichte educatie om de kwaliteit van de acute hartfalenbehandeling te verbeteren.","abstract_original":"AIMS: To assess clinicians' decision-making in relation to guideline-recommended diuretic therapy, monitoring, and escalation strategies in acute heart failure (AHF). METHODS AND RESULTS: We conducted a multinational, case-based cross-sectional survey among clinicians involved in heart failure management in Switzerland, Germany, and Austria. Participants responded to standardized hypothetical clinical vignettes addressing loop diuretic dosing, monitoring, and management of insufficient diuretic response in patients with AHF. Multivariable binomial logistic regression was used to identify factors associated with guideline-concordant initial diuretic dosing and use of urinary sodium measurement. A total of 787 clinicians participated. Guideline-concordant initial loop diuretic dosing was reported by 53.4% of respondents for diuretic-naive patients and by 87.7% for patients receiving chronic diuretic therapy. Treatment monitoring using urinary sodium measurement was reported by 16.9%. In multivariable regression analysis, urinary sodium measurement was more frequent in Switzerland (OR 3.36; 95% CI 2.09-5.42) and Austria (OR 2.64; 95% CI 1.12-6.22) compared to Germany. General practitioners/internal medicine physicians (OR 3.52, 95% CI 1.83-6.79), resident physicians (OR 2.60, 95% CI 1.50-4.51), and prehospital emergency physicians (OR 2.08, 95% CI 1.08-4.03) showed higher odds of urinary sodium measurement compared to emergency medicine physicians. In rural settings, odds were lower compared to urban settings (OR 0.50, 95% CI 0.29-0.88). In case of insufficient diuretic response, 64.6% favoured escalation via sequential nephron blockade. 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."}