Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine.
Patients with acute heart failure (AHF) require urgent in-hospital treatment for relief of symptoms. The main reason for hospitalization is congestion, rather than low cardiac output. Although congestion is associated with a poor prognosis, many patients are discharged with persistent signs and symptoms of congestion and/or a high left ventricular filling pressure. Available data suggest that a pre-discharge clinical assessment of congestion is often not performed, and even when it is performed, it is not done systematically because no method to assess congestion prior to discharge has been validated. Grading congestion would be helpful for initiating and following response to therapy. We have reviewed a variety of strategies to assess congestion which should be considered in the care of patients admitted with HF. We propose a combination of available measurements of congestion. Key elements in the measurement of congestion include bedside assessment, laboratory analysis, and dynamic manoeuvres. These strategies expand by suggesting a routine assessment of congestion and a pre-discharge scoring system. A point system is used to quantify the degree of congestion. This score offers a new instrument to direct both current and investigational therapies designed to optimize volume status during and after hospitalization. In conclusion, this document reviews the available methods of evaluating congestion, provides suggestions on how to properly perform these measurements, and proposes a method to quantify the amount of congestion present.
Gheorghiade
Mihai
M
Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Follath
Ferenc
F
Ponikowski
Piotr
P
Barsuk
Jeffrey H
JH
Blair
John E A
JE
Cleland
John G
JG
Dickstein
Kenneth
K
Drazner
Mark H
MH
Fonarow
Gregg C
GC
Jaarsma
Tiny
T
Jondeau
Guillaume
G
Sendon
Jose Lopez
JL
Mebazaa
Alexander
A
Metra
Marco
M
Nieminen
Markku
M
Pang
Peter S
PS
Seferovic
Petar
P
Stevenson
Lynne W
LW
van Veldhuisen
Dirk J
DJ
Zannad
Faiez
F
Anker
Stefan D
SD
Rhodes
Andrew
A
McMurray
John J V
JJ
Filippatos
Gerasimos
G
D000465:Algorithms; D002309:Cardiology / Q000639:trends*; D003422:Critical Care / Q000639:trends*; D004244:Dizziness; D004417:Dyspnea; D004489:Edema, Cardiac; D005060:Europe; D006305:Health Status Indicators; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D005082:Physical Exertion; D011379:Prognosis; D012135:Respiratory Sounds; D018570:Risk Assessment; D012955:Societies, Medical