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Worsening heart failure (HF) is associated with a high risk of death and rehospitalization. Despite that, real world evidence about the impact of worsening HF on clinical practice is scarce. A narrative review about registries addressing recent worsening HF events in Spain, with special emphasis on patients recently hospitalized for HF was performed. Worsening HF can be defined as situations where the patient's HF deteriorates to the extent that it necessitates initiation or intensification of diuretic treatment (mainly intravenous). The events can occur at the outpatient level, generally in the day hospital, in the emergency department or even hospitalization. Early identification of worsening HF events is essential to establish appropriate treatment as soon as possible. In this context, robust clinical benefits have been reported for renin-angiotensin system inhibitors, sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and vericiguat. In Spain, several registries of patients with HF have been developed, some of them including patients recently hospitalized for HF, but not with recent worsening HF events. Therefore, registries addressing recent worsening events would be desirable. Using a practical approach, this review analyzes the importance of worsening HF events, with special emphasis on Spanish data. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusions Combination of hypertonic saline solution (HSS) with intravenous loop diuretics has been suggested to improve diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this approach in the ambulatory setting remain unexplored.In this multicentre, double‐blind, randomized study, we allocated ambulatory patients with worsening heart failure (WHF) to a 1‐h infusion of intravenous furosemide (ivFurosemide)‐HSS versus ivFurosemide. The primary endpoint was the volume of diuresis at 3 h. Secondary endpoints included 3‐h natriuresis and weight variation, 7‐day congestion data, kidney function and electrolytes, and 30‐day clinical events. Overall, 167 participants (median age: 81 years, 30.5% female) were randomized across 13 sites between December 2020 and March 2023. There were no differences in 3‐h diuresis between treatments (ivFurosemide‐HSS: 1099 ml vs. ivFurosemide: 1103 ml, p = 0.963), 3‐h natriuresis (∆ +2.642 mEq/L, p = 0.559), or 3‐h weight (∆ +0.012 kg, p = 0.920). Patients in the ivFurosemide‐HSS arm experienced significant weight decrease at 7 days (Δ −0.586 kg, p = 0.048). There were no between‐treatment differences in clinical congestion score, biomarkers, inferior vena cava diameter, or the presence of lung ultrasound B‐lines. At 30 days, 26.5% of the patients in the ivFurosemide‐HSS group versus 33.3% in the ivFurosemide group experienced WHF (hazard ratio 0.76, p = 0.330). The incidence of death from any cause or HF hospitalization was 6% of patients in the ivFurosemide‐HSS group and 8.3% of patients in the ivFurosemide group (hazard ratio 0.69, p = 0.521). The incidence of worsening kidney function or metabolic derangements was not significantly different in the two arms.A single infusion of ivFurosemide‐HSS did not improve 3‐h diuresis or congestion parameters in patients with ambulatory WHF. This therapy showed an appropriate safety profile. [ABSTRACT FROM AUTHOR]