Background: Residual congestion in acute heart failure (AHF) is related to poor prognosis. However, we lack data on the prognostic value of changes in a combined assessment of in-hospital congestion. We sought evaluated the association of in-hospital congestion changes with subsequent prognosis according to LVEF classification.
Methods: Patients (N=244, 80.3±7.6 years, 50.8% male) admitted for acute HF in 2 European tertiary care centers underwent clinical assessment, echocardiography, lung ultrasound (LUS) ultrasound and natriuretic peptides (NP) measurement at admission and discharge. The primary outcome was the composite of All-cause mortality and/or HF re-hospitalization.
Results: In the 244 considered patients (95 HfrEF, 57 HFmrEF and 92 HFpEF), limited improvement in clinical congestion score (Hazard ratio 2.33, 1.51 to 3.61, p=0.0001), NP levels (2.29, 1.55 to 3.38, 0.0001) and B-lines count (6.44, 4.19 to 9.89, 0.001), had significnatly higher risk of outcome compared to patients experiencing more sizeable decongestion. The same pattern of association was observed when adjusting on confounding factors. A limited improvement in clinical congestion score and B-lines count was related to poor prognosis in all LVEF categories.
Conclusions: In AHF, the degree of congestion reduction assessed over the in-hospital stay period, can stratify the subsequent event risk. Limited improvement in both clinical congestion and B-lines count are related to poor prognosis irrespectively of LVEF.
