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Record W4417121202 · doi:10.1056/evidctw2500258

Oral Diuretic Intensification as a Worsening Heart Failure Event in the Primary Outcome of Clinical Trials

2025· article· en· W4417121202 on OpenAlexaff
Harriette G.C. Van Spall, Joan Carles Trullàs, Darren K. McGuire, Faïez Zannad, John J.V. McMurray

Bibliographic record

VenueNEJM Evidence · 2025
Typearticle
Languageen
FieldMedicine
TopicHeart Failure Treatment and Management
Canadian institutionsMcMaster UniversityPopulation Health Research Institute
Fundersnot available
KeywordsHeart failureClinical trialDiureticAmbulatoryPharmacotherapyEvent (particle physics)Post-hoc analysisRandomized controlled trial

Abstract

fetched live from OpenAlex

AbstractAlthough evidence-based therapies for patients with heart failure (HF) have decreased all-cause mortality, the residual risk of other clinically relevant outcomes - such as worsening HF - remains high. In this context, contemporary HF trials have increasingly employed composite primary outcomes that include worsening HF, commonly defined as episodes resulting in hospitalization for HF or urgent ambulatory visits with use of intravenous HF pharmacotherapies. In this Clinical Trials Workshop, we propose that the definition of worsening HF in clinical trials be expanded to include HF episodes treated with ambulatory oral diuretic intensification (ODI). Using previously reported post hoc analyses of pharmacotherapy trials in chronic HF, we highlight the prognostic significance of ODI and examine the implications of including ODI on anticipated event rates and estimated treatment effect. We propose a standardized definition of ODI and discuss challenges and regulatory considerations of incorporating ODI into HF trial end points.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.007
metaresearch head score (Gemma)0.009
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesMetaresearch
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.241
Threshold uncertainty score1.000

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0070.009
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.274
GPT teacher head0.521
Teacher spread0.248 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designObservational
Domainnot available
GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations2
Published2025
Admission routes1
Has abstractyes

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