Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure

Jorge Rubio-Gracia, Biniyam G. Demissei, Jozine M. ter Maaten, John G. Cleland, Christopher M. O'Connor, Marco Metra, Piotr Ponikowski, John R. Teerlink, Gad Cotter, Beth A. Davison, Michael M. Givertz, Daniel M. Bloomfield, Howard Dittrich, Kevin Damman, Juan I. Perez-Calvo, Adriaan A. Voors*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

78 Citations (Scopus)

Abstract

Background: Congestion is the main reason for hospital admission for acute decompensatecl heart failure (ADHF). A better understanding of the clinical course of congestion and factors associated with decongestion are therefore important. We studied the clinical course, predictors and prognostic value of congestion in a cohort of patients admitted for ADHF by including different indirect markers of congestion (residual clinical congestion, brain natriuretic peptides (BNP) trajectories, hemoconcentration or diuretic response).

Methods and results: We studied the prognostic value of residual clinical congestion using an established composite congestion score (CCS) in 1572 ADHF patients. At baseline, 1528 (97.2%) patients were significantly congested (CCS >= 3), after 7 days of hospitalization or discharge (whichever came first), 451 (28.7%) patients were still significantly congested (CCS >= 3), 751 (47.8%) patients were mildly congested (CCS = 1 or 2) and 370 (23.5%) patients had no signs of residual congestion (CCS - 0). The presence of significant residual congestion at day 7 or discharge was independently associated with increased risk of re-admissions for heart failure by day 60 (HR [95% CI] 1.88 [1.39-2.551) and all-cause mortality by day 180 (HR [95%CI] 1.54 [1.16-2.041). Diuretic response provided added prognostic value on top of residual congestion and baseline predictors for both outcomes, yet gain in prognostic performance was modest.

Conclusion: Most patients with acute decompensated heart failure still have residual congestion 7 days after hospitalization. This factor was associated with higher rates of re-hospitalization and death. Decongestion surrogates, such as diuretic response, added to residual congestion, are still significant predictors of outcomes, but they do not provide meaningful additive prognostic information. (C) 2018 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)185-191
Number of pages7
JournalInternational Journal of Cardiology
Volume258
DOIs
Publication statusPublished - 1-May-2018

Keywords

  • Heart failure
  • Congestion
  • Diuretic response
  • RECEPTOR ANTAGONIST ROLOFYLLINE
  • REDUCED EJECTION FRACTION
  • RENAL-FUNCTION
  • DIURETIC RESPONSE
  • VENOUS CONGESTION
  • PROGNOSTIC VALUE
  • AN ANALYSIS
  • BIOMARKERS
  • HOSPITALIZATION
  • SYMPTOMS

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