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Journal update monthly top five
  1. Samuel Jonathan Glover1,
  2. David Metcalfe1,
  3. Vishakha Erasu1,
  4. Tine Panduro1,
  5. William Gibbs1,
  6. Immanuel Paul1,
  7. Alex Novak1,
  8. Thomas Alexander Gerrard Shanahan2,3
  1. 1 Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
  3. 3 Emergency Department, Royal Oldham Hospital, Oldham, UK
  1. Correspondence to Dr Samuel Jonathan Glover, Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK; jonny.glover{at}

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This month’s update is by a team from Emergency Medicine Research in Oxford (EMROx). We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as:

Worth a peek—interesting, but not yet ready for prime time.

Head turner—new concepts.

Game changer—this paper could/should change practice.

Door-to-furosemide time and clinical outcomes in acute heart failure

Topic: Diuretics in acute heart failure

Rating: Worth a peek

This paper sought to explore the short-term associations between timing of intravenous (IV) diuretics in acute heart failure (AHF) patients presenting to a single hospital in Portugal.1 The authors conducted a retrospective observational study with 493 patients recruited. Patients were categorised based on time of ED arrival and administration of IV furosemide. The primary outcome was a composite measure of heart failure rehospitalisation and/or cardiovascular death at 30 and 90 days. The patients receiving delayed furosemide (>1 hour from arrival) were less unwell and had lower rates of pulmonary oedema (9.8% vs 23.1%) at baseline but were more likely to experience the composite outcome at 30 days (OR 3.15 (95% CI 1.49 to 6.64)). At 90 days, this effect was no longer statistically significant.

This result is in line with the REALITY AHF study, a multicentre prospective observational study, but conflict with results from other observational studies (both prospective and retrospective). Limitations of the study include the retrospective design; no dosage details for the furosemide …

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  • Contributors SJG identified appropriate papers to be considered for inclusion, authored a review and edited all reviews for content. IP, VE and WG reviewed papers for inclusion and authored a review. TP authored a review. DM reviewed papers for inclusion and edited all reviews for content. AN edited all reviews for content. TAGS was editor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.