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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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Most Read Articles
6 days ago
Immobilization or disuse of the forearm leads to impairment in the ability of a protein-rich meal to promote positive muscle amino acid balance, which is aggravated by dietary lipid oversupply, suggests a study. Disuse also lowers postprandial forearm amino acid uptake, but this is not exacerbated under high-fat conditions.
18 May 2020
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are more effective than basal insulin in the management of total (TC) and low-density lipoprotein cholesterol (LDL-C), reveals a recent study.
17 May 2020
Increased coffee consumption among regular drinkers is associated with higher estimated glomerular filtration rate and confers protection against the risk of chronic kidney disease stages G3–G5 and albuminuria, as shown in a study.
Jairia Dela Cruz, 16 May 2020
Excess weight, greater abdominal fat, inflammation and low physical performance can all contribute to insulin resistance in middle-age Singaporean women, and these variables explain why the condition is more common among women of Chinese than Malay and Indian ethnicities, a study has found.