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Water and Sodium in Heart Failure: A Spotlight on Congestion

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An Editorial Expression of Concern to this article was published on 29 April 2021

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Abstract

Despite all available therapies, the rates of hospitalization and death from heart failure (HF) remain unacceptably high. The most common reasons for hospital admission are symptoms related to congestion. During hospitalization, most patients respond well to standard therapy and are discharged with significantly improved symptoms. Post-discharge, many patients receive diligent and frequent follow-up. However, rehospitalization rates remain high. One potential explanation is a persistent failure by clinicians to adequately manage congestion in the outpatient setting. The failure to successfully manage these patients post-discharge may represent an unmet need to improve the way congestion is both recognized and treated. A primary aim of future HF management may be to improve clinical surveillance to prevent and manage chronic fluid overload while simultaneously maximizing the use of evidence-based therapies with proven long-term benefit. Improvement in cardiac function is the ultimate goal and maintenance of a “dry” clinical profile is important to prevent hospital admission and improve prognosis. This paper focuses on methods for monitoring congestion, and strategies for water and sodium management in the context of the complex interplay between the cardiac and renal systems. A rationale for improving recognition and treatment of congestion is also proposed.

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Conflict of interest

None of the authors have any potential conflict of interest in the submitted manuscript.

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Authors and Affiliations

  1. Biomedical Department of Internal and Specialty Medicine (Di.Bi.M.I.S.), A.O.U.P “Paolo Giaccone”, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy

    Gaspare Parrinello, Daniele Torres & Salvatore Paterna

  2. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Stephen J. Greene & Mihai Gheorghiade

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, USA

    Michael Alderman

  4. Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joseph Vincent Bonventre

  5. Division of Cardiology, GF Ingrassia Hospital, Palermo, Italy

    Pietro Di Pasquale

  6. Institute of Clinical Physiology, National Council of Research, Pisa, Italy

    Luna Gargani

  7. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Anju Nohria & Lynne Warner Stevenson

  8. Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA

    Gregg C. Fonarow

  9. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Muthiah Vaduganathan

  10. Division of Cardiology, Emory University, Atlanta, GA, USA

    Javed Butler

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  1. Gaspare Parrinello
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  2. Stephen J. Greene
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  3. Daniele Torres
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  4. Michael Alderman
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  11. Javed Butler
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Correspondence to Gaspare Parrinello.

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Parrinello, G., Greene, S.J., Torres, D. et al. Water and Sodium in Heart Failure: A Spotlight on Congestion. Heart Fail Rev 20, 13–24 (2015). https://doi.org/10.1007/s10741-014-9438-7

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