Congestive Heart FailureFreedom from congestion predicts good survival despite previous class IV symptoms of heart failure☆,☆☆
Section snippets
Patient population
The population was defined as patients with documented evaluation at the heart failure center 4 to 6 weeks after discharge from hospitalization with class IV symptoms. Patients were identified at the time of hospitalization for heart failure and transplantation consideration (UCLA, 1986 to 1992) or when returning to the clinic after such a hospitalization (Brigham and Women’s, 1994 to 1995). Class IV symptoms of heart failure were defined as symptoms at rest or resulting in inability to perform
Results
The study population included 146 patients discharged after admission to the hospital with class IV symptoms who had a documented return clinic visit at 4 to 6 weeks. Baseline characteristics confirmed advanced heart failure, with average left ventricular ejection fraction of 20%, moderate mitral regurgitation, and serum sodium of 135 mEq/L. During hospitalization, average cardiac index improved from 2.0 to 2.6 L · min · m2 and pulmonary capillary wedge pressure fell from 27 to 15 mm Hg (Table
Discussion
This study demonstrates the significance of maintaining relief from clinical congestion by 4 to 6 weeks after discharge from the hospital. Patients free of congestion at that time, particularly those without orthopnea, had good 2-year survival despite previous hospitalization with NYHA class IV symptoms of heart failure.
References (22)
- et al.
Task Force 3: Recipient Guidelines/Prioritization
J Am Coll Cardiol
(1993) - et al.
Impact of a comprehensive heart failure management program on hospital readmission and functional status for patients with advanced heart failure
J Am Coll Cardiol
(1997) - et al.
Assessing risk by hemodynamic profile in patients awaiting cardiac transplantation
Am J Cardiol
(1994) - et al.
Importance of hemodynamic response to therapy in predicting survival with ejection fraction ≤20%
Am J Cardiol
(1990) - et al.
Afterload reduction with vasodilators and diuretics decreases mitral valve regurgitation during upright exercise in advanced heart failure
J Am Coll Cardiol
(1990) - et al.
Prevalence and hemodynamic correlates of malnutrition in severe heart failure
Am J Cardiol
(1989) - et al.
Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure
J Am Coll Cardiol
(1994) - et al.
Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure
Am Heart J
(1999) - et al.
A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure
N Engl J Med
(1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure
N Engl J Med
(1991)
Effects of enalapril on mortality in severe congestive heart failure
N Engl J Med
Cited by (277)
Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit
2023, JACC: Heart FailurePrognostic implications of post-discharge hemodynamic congestion assessed by peripheral venous pressure among patients discharged from acute heart failure
2023, International Journal of CardiologyRates of In-Hospital Decongestion and Association with Mortality and Cardiovascular Outcomes Among Patients Admitted for Acute Heart Failure
2022, American Journal of MedicineCitation Excerpt :Most hospitalizations for acute heart failure are prompted by signs and symptoms of congestion or volume overload. Clinical congestion has been shown to be a risk factor for mortality and cardiovascular outcomes, with greater degree of congestion at the time of admission being associated with higher risk of mortality and poor cardiovascular outcomes2,3 as well as with short-term and longer-term declines in kidney function.4-6 Successful fluid removal, or decongestion, as evidenced by improvement in clinical signs and symptoms or by hemoconcentration is associated with decreased risk of mortality.7,8
Assessment of clinical and hemodynamic congestion as predictors of mortality in elderly outpatients with heart failure
2022, Revista Clinica EspanolaShould Weight Loss Be Targeted During an Acute Heart Failure Admission?
2022, Journal of Cardiac FailurePrognosis of acute heart failure based on clinical data of congestion
2022, Revista Clinica Espanola
- ☆
Supported in part by the Fannie E. Rippel Foundation, Basking Ridge, NJ, and the WT Young Company, Lexington, Ky.
- ☆☆
Reprint requests: Lynne Warner Stevenson, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail: [email protected]