Acute Heart Failure (AHF)DESTINaTE-AHFNCT07804654
Protocolised Natriuresis-Guided Decongestion at Different Diuretic Intensities in Acute Heart Failure
A study testing Furosemide - HIGH-dose Natriuresis-Guided Strategy and Furosemide - LOW-dose Natriuresis-Guided Strategy in people with Acute Heart Failure (AHF), run by Universiti Teknologi Mara at 1 site in Malaysia.
Trial summary
The goal of this clinical trial is to learn how different doses of a water-removing medicine (diuretic) work in adults admitted to hospital with acute heart failure. It will also assess the safety of these treatment approaches. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Acute Heart Failure (AHF)
- What is being tested?
- Furosemide - HIGH-dose Natriuresis-Guided Strategy and Furosemide - LOW-dose Natriuresis-Guided Strategy
- Type of treatment
- Pill or oral medicine, Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 109 participants
- Where
- 1 siteMalaysia
- Study dates
- 1 Jan 2026to 31 Jul 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age 18 years or older
- Malaysian nationality
- Hospitalised with acute heart failure, either de novo acute heart failure or acute decompensated chronic heart failure
- Clinical evidence of congestion requiring intravenous loop diuretic therapy, with at least one of the following: peripheral oedema, orthopnoea, paroxysmal nocturnal dyspnoea, pulmonary crepitations, elevated jugular venous pressure, ascites, or congestive hepatomegaly
- Able to provide informed consent
Who cannot join
- End-stage renal disease requiring chronic dialysis
- Requirement or anticipated requirement for invasive mechanical ventilation
- Requirement or anticipated requirement for inotropic or vasopressor support
- Requirement or anticipated requirement for renal replacement therapy
- Cardiogenic shock or systolic blood pressure below 100 mmHg
- Pregnancy or breastfeeding
- Known hypersensitivity to furosemide
Trial locations and contacts
1 site in 1 country.
Malaysia1 site
Hospital Al-Sultan Abdullah, Universiti Teknologi MARA
Shah Alam, Selangor, 42300
About this study
Official title: Protocolised Decongestive Strategies With Natriuretic Guidance in Acute Heart Failure - Results of The 'DESTINaTE-AHF' Pilot Randomised Controlled Trial
The goal of this clinical trial is to learn how different doses of a water-removing medicine (diuretic) work in adults admitted to hospital with acute heart failure. It will also assess the safety of these treatment approaches.
The main questions this study aims to answer are:
Read more
Does starting with a higher or lower dose of diuretic affect how much sodium and urine the body removes during the first 24 hours? Are there differences in side effects or short-term health outcomes between the treatment approaches?
Researchers will compare two treatment approaches that use urine sodium and urine output to guide diuretic treatment with standard care. Participants will receive intravenous diuretic treatment and have their urine sodium, urine output, symptoms, blood tests, and clinical outcomes assessed.
Read the detailed description
DESTINaTE-AHF evaluated whether the intensity of upfront intravenous loop diuretic therapy influences early decongestive response when treatment is subsequently guided by objective measures of diuretic response. Urinary sodium concentration and urine output were assessed early after treatment and incorporated into predefined treatment algorithms to identify inadequate response and guide subsequent diuretic therapy during the first 24 hours.
Two natriuresis-guided strategies using different upfront diuretic intensities were evaluated against usual clinician-directed care. This design allowed assessment of whether the initial intensity of loop diuretic therapy influences subsequent natriuretic and diuretic response within a protocolised response-guided approach.
- Conditions
- Acute Heart Failure (AHF)
- Being tested
- Furosemide - HIGH-dose Natriuresis-Guided Strategy, Furosemide - LOW-dose Natriuresis-Guided Strategy, Loop Diuretic - Standard of Care
- Keywords
- Acute Heart Failure, Natriuresis, Furosemide, Diuresis, Sodium
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Furosemide - HIGH-dose Natriuresis-Guided StrategyDrug
Also called HIGH-dose
Intravenous furosemide was administered according to a predefined HIGH-dose natriuresis-guided protocol during the first 24 hours. For participants not receiving chronic loop diuretic therapy, the protocol-defined 24-hour dose was 80 mg. For chronic loop diuretic users, the protocol-defined 24-hour dose was calculated as 2.5 times their total home oral daily furosemide-equivalent dose and administered intravenously in divided doses. Urinary sodium at 2 and 6 hours and urine output at 6 hours were used to guide subsequent dosing according to predefined response criteria.
Furosemide - LOW-dose Natriuresis-Guided StrategyDrug
Also called LOW-dose
Intravenous furosemide was administered according to a predefined LOW-dose natriuresis-guided protocol during the first 24 hours. For participants not receiving chronic loop diuretic therapy, the protocol-defined 24-hour dose was 60 mg. For chronic loop diuretic users, the protocol-defined 24-hour dose was calculated as 1.5 times their total home oral daily furosemide-equivalent dose and administered intravenously in divided doses. Urinary sodium at 2 and 6 hours and urine output at 6 hours were used to guide subsequent dosing according to predefined response criteria.
Loop Diuretic - Standard of CareDrug
Also called Standard of Care
Intravenous loop diuretic therapy was administered according to the treating clinician's usual practice. The dose and subsequent adjustment of loop diuretic therapy were determined by the treating clinical team without a protocol-mandated dosing or escalation strategy. Urinary sodium and urine output were assessed at the same study time points as in the natriuresis-guided groups, but no protocol-directed treatment adjustment was mandated based on these measurements.
| Study group | Role | What they receive |
|---|---|---|
| HIGH-dose Natriuresis-Guided Therapy | Experimental | Participants received protocolised HIGH-dose natriuresis-guided intravenous furosemide therapy during the first 24 hours. Receives: Drug: Furosemide - HIGH-dose Natriuresis-Guided Strategy |
| LOW-dose Natriuresis-Guided Therapy | Experimental | Participants received protocolised LOW-dose natriuresis-guided intravenous furosemide therapy during the first 24 hours. Receives: Drug: Furosemide - LOW-dose Natriuresis-Guided Strategy |
| Standard of Care | Active comparator | Participants received intravenous loop diuretic therapy according to the treating clinician's usual practice. Receives: Drug: Loop Diuretic - Standard of Care |
What is being measured
The primary outcome is the main question the study is designed to answer.
24-Hour Urinary Sodium Excretion
Total urinary sodium excretion during the first 24 hours after randomisation, calculated from the 24-hour urine collection and expressed in mmol.
Measured: From randomisation to 24 hours
24-Hour Urine Volume
Total urine volume collected during the first 24 hours after randomisation, expressed in litres.
Measured: From randomisation to 24 hours
Change From Baseline in Breathlessness Likert Score at 24 Hours
Change in participant-reported breathlessness from baseline to 24 hours, assessed using a 5-point Likert scale. Higher scores indicate greater improvement in breathlessness.
Measured: Baseline and 24 hours after randomisation
Secondary outcomes (4)
Length of Stay
Duration of the index hospitalisation, calculated from the first day of hospital admission to discharge and expressed in days.
Measured: From the date of hospital admission until the date of hospital discharge, assessed up to 30 days.
Worsening Renal Function at Discharge
Worsening renal function was defined as a doubling of serum creatinine or a greater than 50% reduction in estimated glomerular filtration rate (eGFR) at hospital discharge compared with baseline.
Measured: From baseline to hospital discharge, assessed up to 30 days.
30-Day Unplanned Heart Failure Rehospitalisation
Number of participants with at least one unplanned hospital readmission for heart failure within 30 days after discharge from the index hospitalisation.
Measured: From hospital discharge to 30 days after discharge
All-Cause Mortality Through 30 Days After Hospital Discharge
Number of participants who died from any cause from randomisation through 30 days after hospital discharge, including deaths occurring during the index hospitalisation.
Measured: From randomisation to 30 days after hospital discharge
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Sep 2026
- Study start1 Jan 2026
- Primary completion1 Jul 2026
- Study completion31 Jul 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Acute Heart Failure (AHF)Studies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 109 participants (actual)
Sponsor and investigators
- Lead sponsor
- Universiti Teknologi Mara
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Nor Afiqah binti Mohd Sebri, Universiti Teknologi Mara
- Investigators
- Nor Afiqah Mohd Sebri, MB BCh BAO, Principal investigator, Universiti Teknologi Mara
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07804654
- Sponsor's protocol ID
- DESTINaTE-AHF
- Acronym
- DESTINaTE-AHF
- Status last verified
- Aug 2026
- First submitted
- 27 Aug 2026
- Last updated
- 4 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be made publicly available due to participant confidentiality and institutional and ethical requirements governing access to the study data.
Publications
Al-Shammari AS, Hamzah KA, Masanabadi M, Asif M, Budhiraja M, Shafi N, Hamed BM, Kurmasha YH, Shweliya MA, Sattar Y. Urinary sodium-guided diuretic therapy in acute decompensated heart failure: A grade assessed systematic review and meta-analysis with trial sequential analysis. Curr Probl Cardiol. 2026 May;51(5):103272. doi: 10.1016/j.cpcardiol.2026.103272. Epub 2026 Jan 20.
PubMed 41571219Meekers E, Dauw J, Ter Maaten JM, Martens P, Nijst P, Verbrugge FH, Van Es M, Erzeel J, Damman K, Trullas JC, Dupont M, Mullens W. Urinary sodium analysis: The key to effective diuretic titration? European Journal of Heart Failure expert consensus document. Eur J Heart Fail. 2025 Jun;27(6):940-949. doi: 10.1002/ejhf.3632. Epub 2025 Feb 27.
PubMed 40017142ter Maaten JM, Valente MA, Damman K, Hillege HL, Navis G, Voors AA. Diuretic response in acute heart failure-pathophysiology, evaluation, and therapy. Nat Rev Cardiol. 2015 Mar;12(3):184-92. doi: 10.1038/nrcardio.2014.215. Epub 2015 Jan 6.
PubMed 25560378Wan Ahmad WA, Abdul Ghapar AK, Zainal Abidin HA, Karthikesan D, Ross NT, S K Abdul Kader MA, Loch A, Mahendran K, Ramli AW, Ong TK, Mohd Amin NH, Lee CY, Che Hassan HH, Zainal Abidin SK, Liew HB, Ho WS, Mohd Ghazi A. Characteristics of patients admitted with heart failure: Insights from the first Malaysian Heart Failure Registry. ESC Heart Fail. 2024 Apr;11(2):727-736. doi: 10.1002/ehf2.14608. Epub 2023 Dec 22.
PubMed 38131217Damman K, Ter Maaten JM, Coster JE, Krikken JA, van Deursen VM, Krijnen HK, Hofman M, Nieuwland W, van Veldhuisen DJ, Voors AA, van der Meer P. Clinical importance of urinary sodium excretion in acute heart failure. Eur J Heart Fail. 2020 Aug;22(8):1438-1447. doi: 10.1002/ejhf.1753. Epub 2020 Feb 22.
PubMed 32086996McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. No abstract available.
PubMed 34447992Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063. Epub 2022 Apr 1.
PubMed 35363499Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Mar 17;75(10):1178-1195. doi: 10.1016/j.jacc.2019.12.059.
PubMed 32164892Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019 Feb;21(2):137-155. doi: 10.1002/ejhf.1369. Epub 2019 Jan 1.
PubMed 30600580Dauw J, Charaya K, Lelonek M, Zegri-Reiriz I, Nasr S, Paredes-Paucar CP, Borbely A, Erdal F, Benkouar R, Cobo-Marcos M, Barge-Caballero G, George V, Zara C, Ross NT, Barker D, Lekhakul A, Frea S, Ghazi AM, Knappe D, Doghmi N, Klincheva M, Fialho I, Bovolo V, Findeisen H, Alhaddad IA, Galluzzo A, de la Espriella R, Tabbalat R, Miro O, Singh JS, Nijst P, Dupont M, Martens P, Mullens W. Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study. Circ Heart Fail. 2024 Jan;17(1):e011105. doi: 10.1161/CIRCHEARTFAILURE.123.011105. Epub 2024 Jan 5.
PubMed 38179728Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419.
PubMed 21366472Ter Maaten JM, Beldhuis IE, van der Meer P, Krikken JA, Postmus D, Coster JE, Nieuwland W, van Veldhuisen DJ, Voors AA, Damman K. Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial. Nat Med. 2023 Oct;29(10):2625-2632. doi: 10.1038/s41591-023-02532-z. Epub 2023 Aug 28.
PubMed 37640861
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Protocolised Decongestive Strategies With Natriuretic Guidance in Acute Heart Failure - Results of The 'DESTINaTE-AHF' Pilot Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT07804654
- Acronym / sponsor ID
- DESTINaTE-AHF / DESTINaTE-AHF
- Conditions
- Acute Heart Failure (AHF)
- Keywords
- Acute Heart Failure, Natriuresis, Furosemide, Diuresis, Sodium
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 109 participants (actual)
- Lead sponsor
- Universiti Teknologi MaraUniversity, hospital or other
- Study start
- 1 Jan 2026 (actual)
- Primary completion
- 1 Jul 2026 (actual)
- Study completion
- 31 Jul 2026 (actual)
- First posted
- 4 Sep 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to learn how different doses of a water-removing medicine (diuretic) work in adults admitted to hospital with acute heart failure. It will also assess the safety of these treatment approaches.
The main questions this study aims to answer are:
Does starting with a higher or lower dose of diuretic affect how much sodium and urine the body removes during the first 24 hours? Are there differences in side effects or short-term health outcomes between the treatment approaches?
Researchers will compare two treatment approaches that use urine sodium and urine output to guide diuretic treatment with standard care. Participants will receive intravenous diuretic treatment and have their urine sodium, urine output, symptoms, blood tests, and clinical outcomes assessed.
Detailed description
DESTINaTE-AHF evaluated whether the intensity of upfront intravenous loop diuretic therapy influences early decongestive response when treatment is subsequently guided by objective measures of diuretic response. Urinary sodium concentration and urine output were assessed early after treatment and incorporated into predefined treatment algorithms to identify inadequate response and guide subsequent diuretic therapy during the first 24 hours.
Two natriuresis-guided strategies using different upfront diuretic intensities were evaluated against usual clinician-directed care. This design allowed assessment of whether the initial intensity of loop diuretic therapy influences subsequent natriuretic and diuretic response within a protocolised response-guided approach.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| HIGH-dose Natriuresis-Guided Therapy | Experimental | Drug: Furosemide - HIGH-dose Natriuresis-Guided StrategyParticipants received protocolised HIGH-dose natriuresis-guided intravenous furosemide therapy during the first 24 hours. |
| LOW-dose Natriuresis-Guided Therapy | Experimental | Drug: Furosemide - LOW-dose Natriuresis-Guided StrategyParticipants received protocolised LOW-dose natriuresis-guided intravenous furosemide therapy during the first 24 hours. |
| Standard of Care | Active comparator | Drug: Loop Diuretic - Standard of CareParticipants received intravenous loop diuretic therapy according to the treating clinician's usual practice. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age 18 years or older
- Malaysian nationality
- Hospitalised with acute heart failure, either de novo acute heart failure or acute decompensated chronic heart failure
- Clinical evidence of congestion requiring intravenous loop diuretic therapy, with at least one of the following: peripheral oedema, orthopnoea, paroxysmal nocturnal dyspnoea, pulmonary crepitations, elevated jugular venous pressure, ascites, or congestive hepatomegaly
- Able to provide informed consent
Key exclusion criteria (7 listed)
- End-stage renal disease requiring chronic dialysis
- Requirement or anticipated requirement for invasive mechanical ventilation
- Requirement or anticipated requirement for inotropic or vasopressor support
- Requirement or anticipated requirement for renal replacement therapy
- Cardiogenic shock or systolic blood pressure below 100 mmHg
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Furosemide - HIGH-dose Natriuresis-Guided StrategyAlso: HIGH-doseIntravenous furosemide was administered according to a predefined HIGH-dose natriuresis-guided protocol during the first 24 hours. For participants not receiving chronic loop diuretic therapy, the protocol-defined 24-hour dose was 80 mg. For chronic loop diuretic users, the protocol-defined 24-hour dose was calculated as 2.5 times their total home oral daily furosemide-equivalent dose and administered intravenously in divided doses. Urinary sodium at 2 and 6 hours and urine output at 6 hours were used to guide subsequent dosing according to predefined response criteria. | Drug | HIGH-dose Natriuresis-Guided Therapy |
| Furosemide - LOW-dose Natriuresis-Guided StrategyAlso: LOW-doseIntravenous furosemide was administered according to a predefined LOW-dose natriuresis-guided protocol during the first 24 hours. For participants not receiving chronic loop diuretic therapy, the protocol-defined 24-hour dose was 60 mg. For chronic loop diuretic users, the protocol-defined 24-hour dose was calculated as 1.5 times their total home oral daily furosemide-equivalent dose and administered intravenously in divided doses. Urinary sodium at 2 and 6 hours and urine output at 6 hours were used to guide subsequent dosing according to predefined response criteria. | Drug | LOW-dose Natriuresis-Guided Therapy |
| Loop Diuretic - Standard of CareAlso: Standard of CareIntravenous loop diuretic therapy was administered according to the treating clinician's usual practice. The dose and subsequent adjustment of loop diuretic therapy were determined by the treating clinical team without a protocol-mandated dosing or escalation strategy. Urinary sodium and urine output were assessed at the same study time points as in the natriuresis-guided groups, but no protocol-directed treatment adjustment was mandated based on these measurements. | Drug | Standard of Care |
Primary outcome
24-Hour Urinary Sodium Excretion
Time frame: From randomisation to 24 hours
Total urinary sodium excretion during the first 24 hours after randomisation, calculated from the 24-hour urine collection and expressed in mmol.
24-Hour Urine Volume
Time frame: From randomisation to 24 hours
Total urine volume collected during the first 24 hours after randomisation, expressed in litres.
Change From Baseline in Breathlessness Likert Score at 24 Hours
Time frame: Baseline and 24 hours after randomisation
Change in participant-reported breathlessness from baseline to 24 hours, assessed using a 5-point Likert scale. Higher scores indicate greater improvement in breathlessness.
4 secondary outcomes
Length of Stay
Time frame: From the date of hospital admission until the date of hospital discharge, assessed up to 30 days.
Worsening Renal Function at Discharge
Time frame: From baseline to hospital discharge, assessed up to 30 days.
30-Day Unplanned Heart Failure Rehospitalisation
Time frame: From hospital discharge to 30 days after discharge
All-Cause Mortality Through 30 Days After Hospital Discharge
Time frame: From randomisation to 30 days after hospital discharge
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2026.
- Background: PubMed 41571219Al-Shammari AS, Hamzah KA, Masanabadi M, Asif M, Budhiraja M, Shafi N, Hamed BM, Kurmasha YH, Shweliya MA, Sattar Y. Urinary sodium-guided diuretic therapy in acute decompensated heart failure: A grade assessed systematic review and meta-analysis with trial sequential analysis. Curr Probl Cardiol. 2026 May;51(5):103272. doi: 10.1016/j.cpcardiol.2026.103272. Epub 2026 Jan 20.
- Background: PubMed 40017142Meekers E, Dauw J, Ter Maaten JM, Martens P, Nijst P, Verbrugge FH, Van Es M, Erzeel J, Damman K, Trullas JC, Dupont M, Mullens W. Urinary sodium analysis: The key to effective diuretic titration? European Journal of Heart Failure expert consensus document. Eur J Heart Fail. 2025 Jun;27(6):940-949. doi: 10.1002/ejhf.3632. Epub 2025 Feb 27.
- Background: PubMed 25560378ter Maaten JM, Valente MA, Damman K, Hillege HL, Navis G, Voors AA. Diuretic response in acute heart failure-pathophysiology, evaluation, and therapy. Nat Rev Cardiol. 2015 Mar;12(3):184-92. doi: 10.1038/nrcardio.2014.215. Epub 2015 Jan 6.
- Background: PubMed 38131217Wan Ahmad WA, Abdul Ghapar AK, Zainal Abidin HA, Karthikesan D, Ross NT, S K Abdul Kader MA, Loch A, Mahendran K, Ramli AW, Ong TK, Mohd Amin NH, Lee CY, Che Hassan HH, Zainal Abidin SK, Liew HB, Ho WS, Mohd Ghazi A. Characteristics of patients admitted with heart failure: Insights from the first Malaysian Heart Failure Registry. ESC Heart Fail. 2024 Apr;11(2):727-736. doi: 10.1002/ehf2.14608. Epub 2023 Dec 22.
- Background: PubMed 32086996Damman K, Ter Maaten JM, Coster JE, Krikken JA, van Deursen VM, Krijnen HK, Hofman M, Nieuwland W, van Veldhuisen DJ, Voors AA, van der Meer P. Clinical importance of urinary sodium excretion in acute heart failure. Eur J Heart Fail. 2020 Aug;22(8):1438-1447. doi: 10.1002/ejhf.1753. Epub 2020 Feb 22.
- Background: PubMed 34447992McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726. doi: 10.1093/eurheartj/ehab368. No abstract available.
- Background: PubMed 35363499Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW; ACC/AHA Joint Committee Members. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063. Epub 2022 Apr 1.
- Background: PubMed 32164892Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Mar 17;75(10):1178-1195. doi: 10.1016/j.jacc.2019.12.059.
- Background: PubMed 30600580Mullens W, Damman K, Harjola VP, Mebazaa A, Brunner-La Rocca HP, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019 Feb;21(2):137-155. doi: 10.1002/ejhf.1369. Epub 2019 Jan 1.
- Background: PubMed 38179728Dauw J, Charaya K, Lelonek M, Zegri-Reiriz I, Nasr S, Paredes-Paucar CP, Borbely A, Erdal F, Benkouar R, Cobo-Marcos M, Barge-Caballero G, George V, Zara C, Ross NT, Barker D, Lekhakul A, Frea S, Ghazi AM, Knappe D, Doghmi N, Klincheva M, Fialho I, Bovolo V, Findeisen H, Alhaddad IA, Galluzzo A, de la Espriella R, Tabbalat R, Miro O, Singh JS, Nijst P, Dupont M, Martens P, Mullens W. Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study. Circ Heart Fail. 2024 Jan;17(1):e011105. doi: 10.1161/CIRCHEARTFAILURE.123.011105. Epub 2024 Jan 5.
- Background: PubMed 21366472Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419.
- Background: PubMed 37640861Ter Maaten JM, Beldhuis IE, van der Meer P, Krikken JA, Postmus D, Coster JE, Nieuwland W, van Veldhuisen DJ, Voors AA, Damman K. Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial. Nat Med. 2023 Oct;29(10):2625-2632. doi: 10.1038/s41591-023-02532-z. Epub 2023 Aug 28.
- Individual participant dataSharing planned: No. Individual participant data will not be made publicly available due to participant confidentiality and institutional and ethical requirements governing access to the study data.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Nor Afiqah Mohd Sebri, MB BCh BAO principal investigator
Universiti Teknologi Mara
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Furosemide - HIGH-dose Natriuresis-Guided Strategy and Furosemide - LOW-dose Natriuresis-Guided Strategy in people with Acute Heart Failure (AHF), run by Universiti Teknologi Mara at 1 site in Malaysia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Malaysia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
24-Hour Urinary Sodium Excretion (time frame: From randomisation to 24 hours). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07804654, which also lists 12 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.