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Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights from DOSE-AHF and CARRESS-HF.
Circ Heart Fail. 2015 Jun 3;
Authors: Lala A, McNulty SE, Mentz RJ, Dunlay S, Vader JM, AbouEzzeddine OF, DeVore AD, Khazanie P, Redfield MM, Goldsmith SR, Bart BA, Anstrom KJ, Felker M, Hernandez AF, Stevenson LW, NHLBI Heart Failure Network Steering Committee, Investigators, and Apprentice Network
Abstract
BACKGROUND: -Congestion is the most frequent cause for hospitalization in acute decompensated heart failure (ADHF). Although decongestion is a major goal of acute therapy, it is unclear how the clinical components of congestion (e.g., peripheral edema, orthopnea) contribute to outcomes after discharge or how well decongestion is maintained.
METHODS AND RESULTS: -A post-hoc analysis was performed of 496 patients enrolled in the DOSE-AHF and CARRESS-HF trials during hospitalization with ADHF and clinical congestion. A simple "orthodema" congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points, <2 pillows=0 points) and peripheral edema (trace=0 points, moderate=1 point, severe=2 points) at baseline, discharge, and 60-day follow-up. Orthodema scores were classified as absent (score of 0), low-grade (score of 1-2), and high-grade (score of 3-4), and the association with death, rehospitalization or unscheduled medical visits through 60 days was assessed. At baseline, 65% of patients had high-grade orthodema and 35% had low-grade orthodema. At discharge, 52% patients were free from orthodema at discharge (score = 0) and these patients had lower 60-day rates of death, rehospitalization, or unscheduled visits (50%) compared to those with low-grade or high-grade orthodema (52% and 68%, respectively, p=0.038). Of the patients without orthodema at discharge, 27% relapsed to low-grade orthodema and 38% to high-grade orthodema at 60-day follow-up.
CONCLUSIONS: -Increased severity of congestion by a simple orthodema assessment is associated with increased morbidity and mortality. Despite intent to relieve congestion, current therapy often fails to relieve orthodema during hospitalization or to prevent recurrence after discharge. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00608491, NCT00577135.
PMID: 26041600 [PubMed - as supplied by publisher]