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Clinical congestion persists after intensive treatment in heart failure patients

17 Oct 2019

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.”

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