title: Water and sodium in heart failure: a spotlight on congestion.
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.
authors.affiliation: 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@unipa.it.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.forename: Daniele
authors.initials: D
authors.lastname: Torres
authors.forename: Michael
authors.initials: M
authors.lastname: Alderman
authors.forename: Joseph Vincent
authors.initials: JV
authors.lastname: Bonventre
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.forename: Anju
authors.initials: A
authors.lastname: Nohria
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
authors.forename: Lynne Warner
authors.initials: LW
authors.lastname: Stevenson
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D015415:Biomarkers; D001834:Body Water; D059347:Cardio-Renal Syndrome; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D010351:Patient Discharge; D011379:Prognosis; D012982:Sodium, Dietary / Q000097:blood / Q000592:standards*; D063189:Symptom Assessment
chemical_list: D015415:Biomarkers; D004232:Diuretics; D012982:Sodium, Dietary