title: 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.
abstract: 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.
authors.affiliation: Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Barsuk
authors.forename: John E A
authors.initials: JE
authors.lastname: Blair
authors.forename: John G
authors.initials: JG
authors.lastname: Cleland
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jondeau
authors.forename: Jose Lopez
authors.initials: JL
authors.lastname: Sendon
authors.forename: Alexander
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Markku
authors.initials: M
authors.lastname: Nieminen
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Petar
authors.initials: P
authors.lastname: Seferovic
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: 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