Home‐based urinary sodium monitoring via point‐of‐care testing for personalized diuretic titration in heart failure management: The EASY‐STOP study

AimsLoop diuretics alleviate symptoms in heart failure (HF), but despite recommendations for dynamic dosing, implementation in practice remains challenging. The EASY‐STOP trial investigated whether ambulatory urinary sodium monitoring using a point‐of‐care sensor could guide diuretic down‐titration.Methods and resultsThis prospective, single‐centre study enrolled 50 euvolaemic HF patients on stable guideline‐directed medical therapy for ≥3 months and receiving maintenance loop diuretic (≥20 mg furosemide equivalent daily). After a 1‐week baseline phase of daily self‐measured first‐void and post‐diuretic urinary sodium assessment, loop diuretics were gradually reduced by 50% and discontinued when ≤20 mg furosemide equivalents. Urinary monitoring continued for another 3 weeks. Successful down‐titration was defined as remaining congestion‐free (no rise in New York Heart Association class ≥I, oedema, pleural effusion, ascites, rise in right ventricular systolic pressure ≥10 mmHg, or worsening diastolic dysfunction ≥1 grade). Investigators and patients were blinded for urinary sodium analysis during the study. Patients were 75 (68–79) years old, had left ventricular ejection fraction 46 (± 11)%, estimated glomerular filtration rate 47 (35–65) ml/min and N‐terminal pro‐B‐type natriuretic peptide 899 (326–2558) ng/L. Among the 50 patients, 62 diuretic down‐titrations were performed, of which 34 (55%) were successful. Baseline urinary sodium before loop diuretic down‐titration was similar between groups. However, patients who successfully achieved down‐titration exhibited a significant increase in first‐void urinary sodium following down‐titration (53–74 mmol/L, p < 0.001), whereas those requiring reinitiation showed no significant change (56–58 mmol/L, p = 0.331). A 10 mmol/L increase predicted successful down‐titration with 79.4% sensitivity and 78.6% specificity (area under the curve = 0.851).ConclusionsPoint‐of‐care urinary sodium monitoring may represent a non‐invasive and personalized approach to diuretic titration in HF management. Further trials are warranted to validate its clinical utility and long‐term benefits.