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

Rubio-Gracia, Jorge (Universidad de Zaragoza) ; 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, Juan I. (Universidad de Zaragoza) ; Voors, A.A.

Resumen: 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.

Idioma: Inglés

DOI: 10.1016/j.ijcard.2018.01.067

Año: 2018

Publicado en: INTERNATIONAL JOURNAL OF CARDIOLOGY 258 (2018), 185-191
ISSN: 0167-5273

Factor impacto JCR: 3.471 (2018)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 48 / 135 = 0.356 (2018) - Q2 - T2

Factor impacto SCIMAGO: 0.99 - Cardiology and Cardiovascular Medicine (Q2)

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)