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Kenig A, Kolben Y, Asleh R, et al. Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm. Front Cardiovasc Med. 2021;8:695547doi: 10.3389/fcvm.2021.695547.
Kenig, A., Kolben, Y., Asleh, R., Amir, O., & Ilan, Y. (2021). Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm. Frontiers in cardiovascular medicine, 8695547. https://doi.org/10.3389/fcvm.2021.695547
Kenig, Ariel, et al. "Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm." Frontiers in cardiovascular medicine vol. 8 (2021): 695547. doi: https://doi.org/10.3389/fcvm.2021.695547
Kenig A, Kolben Y, Asleh R, Amir O, Ilan Y. Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm. Front Cardiovasc Med. 2021 Aug 11;8:695547. doi: 10.3389/fcvm.2021.695547. eCollection 2021. PMID: 34458334; PMCID: PMC8385752.
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Front Cardiovasc Med. 2021 Aug 11;8:695547. doi: 10.3389/fcvm.2021.695547. eCollection 2021.

Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm.

Frontiers in cardiovascular medicine

Ariel Kenig, Yotam Kolben, Rabea Asleh, Offer Amir, Yaron Ilan

Affiliations

  1. Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
  2. Department of Cardiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
  3. The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.

PMID: 34458334 PMCID: PMC8385752 DOI: 10.3389/fcvm.2021.695547

Abstract

Heart failure is a major public health problem, which is associated with significant mortality, morbidity, and healthcare expenditures. A substantial amount of the morbidity is attributed to volume overload, for which loop diuretics are a mandatory treatment. However, the variability in response to diuretics and development of diuretic resistance adversely affect the clinical outcomes. Morevoer, there exists a marked intra- and inter-patient variability in response to diuretics that affects the clinical course and related adverse outcomes. In the present article, we review the mechanisms underlying the development of diuretic resistance. The role of the autonomic nervous system and chronobiology in the pathogenesis of congestive heart failure and response to therapy are also discussed. Establishing a novel model for overcoming diuretic resistance is presented based on a patient-tailored variability and chronotherapy-guided machine learning algorithm that comprises clinical, laboratory, and sensor-derived inputs, including inputs from pulmonary artery measurements. Inter- and intra-patient signatures of variabilities, alterations of biological clock, and autonomic nervous system responses are embedded into the algorithm; thus, it may enable a tailored dose regimen in a continuous manner that accommodates the highly dynamic complex system.

Copyright © 2021 Kenig, Kolben, Asleh, Amir and Ilan.

Keywords: chronobiology; digital systems; diuretic resistance; heart failure; variability

Conflict of interest statement

YI was the founder of Oberon Sciences. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential

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