Integrating the BAN-ADHF diuretic resistance score into same day emergency care centres for heart failure management: a conceptual framework

Early recognition of diuretic resistance is essential for preventing avoidable admissions and progression of acute decompensated heart failure. This Perspective synthesises current evidence and proposes a pragmatic, digitally enabled framework for embedding the Blood Urea Nitrogen, Atrial Fibrillation, N-terminal pro-B-type natriuretic peptide Acute Decompensated Heart Failure (BAN-ADHF) score into United Kingdom same-day emergency care services. Drawing on established electronic health record capabilities and the Fast Healthcare Interoperability Resources standard, we describe a three-touch-point workflow to stratify patients into low, moderate, or high-risk tiers of diuretic resistance and generate tier-specific recommendations for oral up-titration or intravenous sequential nephron blockade. Recent data demonstrating greater natriuresis without excess renal toxicity at higher score thresholds inform these protocolised actions. By integrating the automated risk stratification with tier-specific therapy, the proposed framework aims to reduce therapeutic inertia, lighten clinician workload, and align with the National Health Service mandate for digitally supported community care. Prospective evaluation is warranted to confirm clinical and economic benefits.