Efficacy of rapid decongestion strategy in patients hospitalized for acute heart failure

Mitsutoshi Oguri, Hideki Ishii, Kunihiko Takahara, Kenichiro Yasuda, Tomonobu Takikawa, Takuya Sumi, Hiroshi Takahashi, Toyoaki Murohara

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Clinical congestion is the most dominant feature in patients with acute decompensated heart failure (HF). However, uncertainty exists due to the permutations and combinations of congestion status and decongestion strategies. This study investigated the effect of congestion status and its improvement on 1-year mortality. Methods and Results: In all, 453 consecutive patients hospitalized for acute decompensated HF between July 2015 and March 2017 were prospectively included in the study. Congestion was evaluated using the congestion score. The 1-year mortality rate was 22.7%. The mean (±SD) congestion scores at admission, on Day 3, and at discharge were 10.7±3.9, 3.4±3.5, and 0.3±0.8, respectively. The improvement rate in congestion scores during the first 3 days was 78%; 46.6% of patients had residual congestion. The Day 3 congestion score and the improvement rate during the first 3 days were related to 1-year all-cause mortality and cardiovascular mortality. Combined predictive values were examined by calculating multivariable-adjusted hazard ratios for associations of residual congestion and improvement rate during the first 3 days, and prognostic variables identified by the Cox regression model. Residual congestion and lesser improvement (<64%) were associated with higher relative risk of 1-year all-cause mortality and cardiovascular mortality than residual congestion and higher improvement (≥64%) or resolved congestion. Conclusions: Rapid decongestion could be a prerequisite regardless of residual congestion in hospitalized acute decompensated HF patients.

Original languageEnglish
Pages (from-to)958-964
Number of pages7
JournalCirculation Journal
Volume84
Issue number6
DOIs
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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