Clinical congestion persists after intensive treatment in heart failure patients

While intensive treatment decreases the prevalence of clinical congestion, it remains sufficiently common in patients with heart failure, a recent study has found.

The study included 588 patients (mean age, 77±8 years; 60 percent male) with chronic heart failure and New York Heart Association (NYHA) functional class ≥II. The primary study outcomes were survival and hospitalization-free heart failure survival. Congestion-related signs and symptoms analysed were NYHA ≥III, orthopnoea, paroxysmal nocturnal dyspnoea, rales, jugular venous distension, peripheral pitting oedema and hepatomegaly.

The prevalence rates of congested-related symptoms were high at baseline but decreased over a median follow-up of 27.2 months. In the same time frame, 39 percent of the participants died.

Upon multivariate Cox regression analysis, Clinical Congestion Index, a composite of the aforementioned seven variables, emerged as a significantly predictive variable for death at baseline (hazard ratio [HR], 1.13, 95 percent CI, 1.04–1.22) and at 1 (HR, 1.17, 1.06–1.29), 3 (HR, 1.17, 1.05–1.31), 12 (HR, 1.14, 1.00–1.29) and 18 (HR, 1.25, 1.08–1.45) months.

Similarly, the Index was significantly correlated with death or hospitalization for heart failure at all time points: baseline (HR, 1.12, 1.05–1.20) and 1 (HR, 1.16, 1.07–1.26), 3 (HR, 1.23, 1.12–1.35), 6 (HR, 1.25, 1.13–1.39), 12 (HR, 1.20, 1.08–1.34) and 18 (HR, 1.35, 1.03–1.77) months.

“Intensification of therapy for heart failure resulted in significant reduction of congestion during the initial 6 months. However, congestion persisted or relapsed in a significant proportion of patients,” said researchers. “Still, it remains to be determined how to best achieve decongestion and if it is possible in all patients.”