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

Rubio-Gracia, J. et al. (2018) Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. International Journal of Cardiology, 258, pp. 185-191. (doi: 10.1016/j.ijcard.2018.01.067) (PMID:29544928)

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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 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 [1.39–2.55]) and all-cause mortality by day 180 (HR [95%CI] = 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 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.

Item Type:Articles
Additional Information:The PROTECT trial was supported by NovaCardia, a subsidiary of Merck.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Damman, Dr Kevin
Authors: Rubio-Gracia, J., Demissei, B. G., ter Maaten, J. M., Cleland, J. G., O'Connor, C. M., Metra, M., Ponikowski, P., Teerlink, J. R., Cotter, G., Davison, B. A., Givertz, M. M., Bloomfield, D. M., Dittrich, H., Damman, K., Pérez-Calvo, J. I., and Voors, A. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:13 March 2018
Copyright Holders:Copyright © 2018 Elsevier B.V.
First Published:First published in International Journal of Cardiology 258: 185-191
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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