TY - JOUR
T1 - Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure
T2 - Insights From TIME-CHF Trial
AU - Simonavicius, Justas
AU - Van-Wijk, Sandra Sanders
AU - Rickenbacher, Peter
AU - Maeder, Micha T.
AU - Pfister, Otmar
AU - Kaufmann, Beat A.
AU - Pfisterer, Matthias
AU - Celutkiene, Jelena
AU - Puronaite, Roma
AU - Knackstedt, Christian
AU - van Empel, Vanessa
AU - Brunner-La Rocca, Hans-Peter
PY - 2019/9
Y1 - 2019/9
N2 - BACKGROUND: The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure.METHODS: A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class >= II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA >= III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.RESULTS: Sixty-one percent of patients had a Clinical Congestion Index >= 3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and >= 3 at inclusion, respectively, died (P <.001). Clinical Congestion Index was identified as an independent predictor of mortality at all visits (P <.05) except month 6 and reduced hospitalization-free heart failure survival (P <.05). Successful decongestion was related to better outcome as compared to persistent congestion or partial decongestion (log-rank P <0.001).CONCLUSIONS: The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure. (C) 2019 Elsevier Inc. All rights reserved.
AB - BACKGROUND: The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure.METHODS: A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class >= II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA >= III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.RESULTS: Sixty-one percent of patients had a Clinical Congestion Index >= 3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and >= 3 at inclusion, respectively, died (P <.001). Clinical Congestion Index was identified as an independent predictor of mortality at all visits (P <.05) except month 6 and reduced hospitalization-free heart failure survival (P <.05). Successful decongestion was related to better outcome as compared to persistent congestion or partial decongestion (log-rank P <0.001).CONCLUSIONS: The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure. (C) 2019 Elsevier Inc. All rights reserved.
KW - Congestion
KW - Heart failure
KW - Loop diuretic
KW - Prognosis
KW - Signs
KW - Symptoms
KW - STANDARD MEDICAL THERAPY
KW - WORSENING RENAL-FUNCTION
KW - EMERGENCY-DEPARTMENT
KW - ELDERLY-PATIENTS
KW - SYMPTOMS
KW - HOSPITALIZATION
KW - RELIABILITY
KW - MANAGEMENT
KW - PRESSURES
KW - ACCURACY
U2 - 10.1016/j.amjmed.2019.04.010
DO - 10.1016/j.amjmed.2019.04.010
M3 - Article
C2 - 31051151
VL - 132
SP - E679-E692
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 9
ER -