{
  "abstract": "Background: Body weight, urine output, urinary sodium, and ultrasound findings are frequently used as early trial endpoints in acute heart failure (AHF). However, patient-level prognostic associations with residual congestion do not establish the fact that treatment-induced marker improvement predicts fewer deaths or heart failure events.\n\nObjectives: The objectives of this work are to pair short-term decongestion and subsequent clinical treatment effects within the same randomized comparisons, explore the trial-level association for body weight, and qualitatively assess non-weight markers.\n\nMethods: PubMed/MEDLINE, OpenAlex, and ClinicalTrials.gov databases were searched through 18 July 2026. Eligible randomized adult AHF trials reported an objective decongestion effect and ≥30-day mortality, heart failure events, or rehospitalization. The amended primary marker was weight change at 24–96 h (original window, 48–96 h); clinical effects were log hazard or risk ratios. An errors-in-variables meta-regression model used 10,000 trial cluster bootstrap fits and trial-level jackknife intervals.\n\nResults: Twenty-four trials (27 reports) were accepted for qualitative synthesis; the primary analysis included 12 comparisons from only 10 independent trials. Endpoints, follow-up (30–302 days), effect measures, and mechanisms were heterogeneous. Each additional 1-kg between-group difference in weight loss corresponded to a clinical effect ratio of 0.74 (percentile 95% interval, 0.56–1.26; jackknife, 0.49–1.11). The pharmacological-only estimate was 1.04. Evidence for urine output, urinary sodium, and ultrasound was also inconsistent.\n\nConclusions: Short-term weight loss showed a directional but non-robust trial-level association with clinical benefit. The randomized trial-level evidence evaluated here is insufficient to validate short-term weight change as a surrogate for post-discharge clinical outcomes in AHF.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, the Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Huiming Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Hang Fang"
    },
    {
      "affs": [
        0
      ],
      "name": "Mengqi Wu"
    },
    {
      "affs": [
        0
      ],
      "name": "Qiang Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Anyi Fu"
    },
    {
      "affs": [
        0
      ],
      "name": "Mengdan Xu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6eq1tj9vyr0yv.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1942130",
  "fulltext_url": null,
  "id": "6eq1tj9vyr0yv",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1942130/full",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/6eq1tj9vyr0yv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1942130",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1942130/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2297-055X",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Short-term decongestion and clinical benefit in acute heart failure: a systematic review and trial-level meta-regression",
  "title_text": "Short-term decongestion and clinical benefit in acute heart failure: a systematic review and trial-level meta-regression",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T00:21:04Z",
  "url": "https://research.draconitic.com/paper/6eq1tj9vyr0yv",
  "venue": "Frontiers in Cardiovascular Medicine",
  "versions": []
}