doi:10.1016/j.ijcard.2018.01.067engRubio-Gracia, JorgeDemissei, 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, Juan I.Voors, A.A.Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failureART-2018-105392Background: 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.2018http://zaguan.unizar.es/record/8783110.1016/j.ijcard.2018.01.067http://zaguan.unizar.es/record/87831oai:zaguan.unizar.es:87831INTERNATIONAL JOURNAL OF CARDIOLOGY 258 (2018), 185-191by-nc-ndhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccess