Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine

Gheorghiade, M. et al. (2010) Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. European Journal of Heart Failure, 12(5), pp. 423-433. (doi: 10.1093/eurjhf/hfq045)

Abstract

Patients with acute heart failure (AHF) require urgent in-hospital treatment for relief of symptoms. The main reason for hospitalization is congestion, rather than low cardiac output. Although congestion is associated with a poor prognosis, many patients are discharged with persistent signs and symptoms of congestion and/or a high left ventricular filling pressure. Available data suggest that a pre-discharge clinical assessment of congestion is often not performed, and even when it is performed, it is not done systematically because no method to assess congestion prior to discharge has been validated. Grading congestion would be helpful for initiating and following response to therapy. We have reviewed a variety of strategies to assess congestion which should be considered in the care of patients admitted with HF. We propose a combination of available measurements of congestion. Key elements in the measurement of congestion include bedside assessment, laboratory analysis, and dynamic manoeuvres. These strategies expand by suggesting a routine assessment of congestion and a pre-discharge scoring system. A point system is used to quantify the degree of congestion. This score offers a new instrument to direct both current and investigational therapies designed to optimize volume status during and after hospitalization. In conclusion, this document reviews the available methods of evaluating congestion, provides suggestions on how to properly perform these measurements, and proposes a method to quantify the amount of congestion present

• Item Type: Articles
• Keywords: acute heart failure ASSOCIATION BEDSIDE VALSALVA MANEUVER BLOOD UREA NITROGEN CARE Congestion DILATED CARDIOMYOPATHY DISCHARGE ENGLAND FAILURE FILLING PRESSURES HEART Heart failure HEART-FAILURE LEFT-VENTRICULAR DYSFUNCTION Measurement MS NATRIURETIC PEPTIDE LEVELS PATIENT patients prognosis RIGHT ATRIAL PRESSURE risk assessment Ro SCIENTIFIC STATEMENT SCORE STRATEGY SUGGESTION SYSTEM THERAPY TISSUE DOPPLER-ECHOCARDIOGRAPHY Treatment VASOPRESSIN ANTAGONIST WORSENING RENAL-FUNCTION
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Gheorghiade, M., Follath, F., Ponikowski, P., Barsuk, J. H., Blair, J. E. A., Cleland, J. G., Dickstein, K., Drazner, M. H., Fonarow, G. C., Jaarsma, T., Jondeau, G., Sendon, J. L., Mebazaa, A., Metra, M., Nieminen, M., Pang, P. S., Seferovic, P., Stevenson, L. W., van Veldhuisen, D. J., Zannad, F., Anker, S. D., Rhodes, A., McMurray, J.J.V., and Filippatos, G.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences
• Journal Name: European Journal of Heart Failure
• ISSN: 1388-9842