External validation of the BAN-ADHF diuretic-resistance score in the DAPA-RESIST clinical trial

Diuretic resistance in worsening heart failure (HF) is associated with poorer outcomes and, although common, can be challenging to identify. The recently developed BAN-ADHF score can potentially identify patients with worsening HF at risk of diuretic resistance. We externally validated the BAN-ADHF diuretic-resistance score in a multicentre randomized trial comparing adjunctive dapagliflozin to metolazone in patients with HF and diuretic resistance. We calculated a seven-variable modified BAN-ADHF score at baseline and dichotomised patients by the median BAN-ADHF score (8). We assessed loop diuretic efficiency (kg weight change per 40-mg furosemide) and decongestion (weight, eight-zone lung ultrasound B-lines, clinical congestion score) over 96 h. A baseline score ≥8 identified lower loop diuretic efficiency (pooled difference -0.12 kg/40 mg, 95% CI -0.18 to -0.06; p < 0.001) despite similar congestion markers at baseline. The BAN-ADHF score may be useful clinically to identify patients at risk of diminished response to diuretics.