title: Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure.
abstract: BACKGROUND
  This study determined whether evidence of congestion after 4 to 6 weeks of heart failure management predicted outcome for patients hospitalized with chronic New York Heart Association class IV symptoms. Class IV symptoms predict high mortality rates, but outcome is not known for patients who improve to establish freedom from congestion. Revised estimates at 1 month could facilitate decisions regarding transplantation and other high-risk interventions.
  
  
  METHODS
  At 4 to 6 weeks after hospital discharge, 146 patients were evaluated for congestion by 5 criteria (orthopnea, jugular venous distention, edema, weight gain, and new increase in baseline diuretics). Heart failure management included inpatient therapy tailored to relieve congestion, followed by adjustments to maintain fluid balance during the next 4 weeks.
  
  
  RESULTS
  Freedom from congestion was demonstrated at 4 to 6 weeks in 80 (54%) patients, who had 87% subsequent 2-year survival compared with 67% in 40 patients with 1 or 2 criteria of congestion and 41% in 26 patients with 3 to 5 criteria. The Cox proportional hazards model identified left ventricular dimension, pulmonary wedge pressure on therapy, and freedom from congestion as independent predictors of survival. Persistence of orthopnea itself predicted 38% 2-year survival (without urgent transplantation) versus 77% in 113 without orthopnea. Serum sodium was lower and blood urea nitrogen and heart rate higher when orthopnea persisted.
  
  
  CONCLUSIONS
  The ability to maintain freedom from congestion identifies a population with good survival despite previous class IV symptoms. At 4 to 6 weeks, patients with persistent congestion may be considered for high-risk intervention.
authors: Cardiovascular Divisions, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors: C
authors: C
authors: Lucas
authors: W
authors: W
authors: Johnson
authors: M A
authors: MA
authors: Hamilton
authors: G C
authors: GC
authors: Fonarow
authors: M A
authors: MA
authors: Woo
authors: C M
authors: CM
authors: Flavell
authors: J A
authors: JA
authors: Creaser
authors: L W
authors: LW
authors: Stevenson
mesh_terms: D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D015996:Survival Rate; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D014665:Vasodilator Agents