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Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial

Justas Simonavičius, Sandra Sanders Van-Wijk, Peter Rickenbacher, Micha T. Maeder, Otmar Pfister, Beat A Kaufmann, Matthias Pfisterer, Jelena Čelutkienė, Roma Puronaitė, Christian Knackstedt, Vanessa Van Empel & Hans-Peter Brunner-La Rocca

abstract

BACKGROUND
The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure.

METHODS
A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class ≥II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA ≥III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.

RESULTS
Sixty-one percent of patients had a Clinical Congestion Index ≥3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and ≥3 at inclusion, respectively, died (P <.001). Clinical Congestion Index was identified as an independent predictor of mortality at all visits (P <.05) except month 6 and reduced hospitalization-free heart failure survival (P <.05). Successful decongestion was related to better outcome as compared to persistent congestion or partial decongestion (log-rank P <0.001).

CONCLUSIONS
The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure.
   
citation Simonavičius J, Sanders Van-Wijk S, Rickenbacher P, Maeder M T, Pfister O, Kaufmann B A, Pfisterer M, Čelutkienė J, Puronaitė R, Knackstedt C, Van Empel V, Brunner-La Rocca H P. Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial. Am J Med 2019; 132:e679-e692.
   
type journal paper/review (English)
date of publishing 30-04-2019
journal title Am J Med (132/9)
ISSN electronic 1555-7162
pages e679-e692
PubMed 31051151
DOI 10.1016/j.amjmed.2019.04.010