Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial |
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Authors: | Justas Simonavičius Sandra Sanders van-Wijk Peter Rickenbacher Micha T. Maeder Otmar Pfister Beat A. Kaufmann Matthias Pfisterer Jelena Čelutkienė Roma Puronaitė Christian Knackstedt Vanessa van Empel Hans-Peter Brunner-La Rocca |
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Affiliation: | 1. Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania;2. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands;3. Department of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland;4. Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland;5. Department of Cardiology, University Hospital Basel, Basel, Switzerland;6. Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania;7. Department of Information Systems, Centre of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania;8. Clinic of Cardiac and Vascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania;9. Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania |
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Abstract: | BackgroundThe 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.MethodsA 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.ResultsSixty-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).ConclusionsThe 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. |
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Keywords: | Requests for reprints should be addressed to Justas Simonavicius, Vilnius University Hospital Santaros klinikos, Centre of Cardiology and Angiology, Santariskiu str. 2, LT-08406, Vilnius, Lithuania. Congestion Heart failure Loop diuretic Prognosis Signs Symptoms |
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