Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure.
Int J Cardiol
; 258: 185-191, 2018 05 01.
Article
in En
| MEDLINE
| ID: mdl-29544928
ABSTRACT
BACKGROUND:
Congestion is the main reason for hospital admission for acute decompensated 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 ANDRESULTS:
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 (CCSâ¯≥â¯3), after 7â¯days of hospitalization or discharge (whichever came first), 451 (28.7%) patients were still significantly congested (CCSâ¯≥â¯3), 751 (47.8%) patients were mildly congested (CCSâ¯=â¯1 or 2) and 370 (23.5%) patients had no signs of residual congestion (CCSâ¯=â¯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]â¯=â¯1.88 [1.39-2.55]) and all-cause mortality by day 180 (HR [95%CI]â¯=â¯1.54 [1.16-2.04]). 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 7â¯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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Failure
Type of study:
Clinical_trials
/
Prevalence_studies
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Int J Cardiol
Year:
2018
Document type:
Article
Affiliation country:
Netherlands