The Burden of Congestion in Patients Hospitalized With Acute Decompensated Heart Failure.

Journal Article (Journal Article)

Congestion is associated with adverse outcomes in heart failure (HF) patients. We characterized congestion in patients hospitalized for HF and examined the association between congestion severity at admission and postdischarge outcomes. Using the OPTIMIZE-HF registry linked to Medicare claims, we analyzed patients ≥65 years old hospitalized for HF from 2003 to 2004. Congestion severity was measured using a 15-point scale that scores dyspnea, orthopnea, fatigue, jugular venous pressure, rales, and edema. Patient characteristics and outcomes were described by congestion strata. Proportional hazards models were fit to examine associations between congestion and 1-year outcomes. Congestion scores for the 24,724 patients ranged from 0 to 14, with a median of 5 (Q1, Q3: 3, 7). At baseline, patients with the highest scores (≥7) had the highest rates of recent HF hospitalizations, EF ≤40%, and co-morbidities, including arrhythmias, diabetes mellitus, and renal insufficiency. Adjusting for patient characteristics, a 3-point congestion score increase was positively associated with mortality (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03, 1.09), all-cause rehospitalization (HR 1.02, 95% CI 1.00, 1.04), and HF rehospitalization (HR 1.09, 95% CI 1.06, 1.12), but not emergency department visits (HR 0.99, 95% CI 0.97, 1.01). In conclusion, for patients hospitalized with HF, congestion was associated with rehospitalization and mortality.

Full Text

Duke Authors

Cited Authors

  • Cooper, LB; Lippmann, SJ; DiBello, JR; Gorsh, B; Curtis, LH; Sikirica, V; Hernandez, AF; Sprecher, DL; Laskey, WK; Saini, R; Fonarow, GC; Hammill, BG

Published Date

  • August 15, 2019

Published In

Volume / Issue

  • 124 / 4

Start / End Page

  • 545 - 553

PubMed ID

  • 31208702

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2019.05.030


  • eng

Conference Location

  • United States