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

Mihai Gheorghiade, Ferenc Follath, Piotr Ponikowski, Jeffrey H. Barsuk, John E A Blair, John G. Cleland, Kenneth Dickstein, Mark H. Drazner, Gregg C. Fonarow, Tiny Jaarsma, Guillaume Jondeau, Jose Lopez Sendon, Alexander Mebazaa, Marco Metra, Markku Nieminen, Peter S. Pang, Petar Seferovic, Lynne W. Stevenson, Dirk J. Van Veldhuisen, Faiez ZannadStefan D. Anker, Andrew Rhodes, John J V McMurray, Gerasimos Filippatos*

*Corresponding author for this work

Research output: Contribution to journalArticle

335 Citations (Scopus)

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 priorto 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.

Original languageEnglish (US)
Pages (from-to)423-433
Number of pages11
JournalEuropean Journal of Heart Failure
Volume12
Issue number5
DOIs
StatePublished - May 1 2010

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Critical Care
Cardiology
Heart Failure
Medicine
Hospitalization
Low Cardiac Output
Investigational Therapies
Ventricular Pressure
Signs and Symptoms
Patient Care
Therapeutics

Keywords

  • Acute heart failure
  • Congestion
  • Risk assessment
  • Score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gheorghiade, Mihai ; Follath, Ferenc ; Ponikowski, Piotr ; Barsuk, Jeffrey H. ; Blair, John E A ; Cleland, John G. ; Dickstein, Kenneth ; Drazner, Mark H. ; Fonarow, Gregg C. ; Jaarsma, Tiny ; Jondeau, Guillaume ; Sendon, Jose Lopez ; Mebazaa, Alexander ; Metra, Marco ; Nieminen, Markku ; Pang, Peter S. ; Seferovic, Petar ; Stevenson, Lynne W. ; Van Veldhuisen, Dirk J. ; Zannad, Faiez ; Anker, Stefan D. ; Rhodes, Andrew ; McMurray, John J V ; Filippatos, Gerasimos. / 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. In: European Journal of Heart Failure. 2010 ; Vol. 12, No. 5. pp. 423-433.
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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 priorto 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.",
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Gheorghiade, M, Follath, F, Ponikowski, P, Barsuk, JH, Blair, JEA, Cleland, JG, Dickstein, K, Drazner, MH, Fonarow, GC, Jaarsma, T, Jondeau, G, Sendon, JL, Mebazaa, A, Metra, M, Nieminen, M, Pang, PS, Seferovic, P, Stevenson, LW, Van Veldhuisen, DJ, Zannad, F, Anker, SD, Rhodes, A, McMurray, JJV & Filippatos, G 2010, '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', European Journal of Heart Failure, vol. 12, no. 5, pp. 423-433. https://doi.org/10.1093/eurjhf/hfq045

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. / Gheorghiade, Mihai; Follath, Ferenc; Ponikowski, Piotr; Barsuk, Jeffrey H.; Blair, John E A; Cleland, John G.; Dickstein, Kenneth; Drazner, Mark H.; Fonarow, Gregg C.; Jaarsma, Tiny; Jondeau, Guillaume; Sendon, Jose Lopez; Mebazaa, Alexander; Metra, Marco; Nieminen, Markku; Pang, Peter S.; Seferovic, Petar; Stevenson, Lynne W.; Van Veldhuisen, Dirk J.; Zannad, Faiez; Anker, Stefan D.; Rhodes, Andrew; McMurray, John J V; Filippatos, Gerasimos.

In: European Journal of Heart Failure, Vol. 12, No. 5, 01.05.2010, p. 423-433.

Research output: Contribution to journalArticle

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T2 - 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

AU - Gheorghiade, Mihai

AU - Follath, Ferenc

AU - Ponikowski, Piotr

AU - Barsuk, Jeffrey H.

AU - Blair, John E A

AU - Cleland, John G.

AU - Dickstein, Kenneth

AU - Drazner, Mark H.

AU - Fonarow, Gregg C.

AU - Jaarsma, Tiny

AU - Jondeau, Guillaume

AU - Sendon, Jose Lopez

AU - Mebazaa, Alexander

AU - Metra, Marco

AU - Nieminen, Markku

AU - Pang, Peter S.

AU - Seferovic, Petar

AU - Stevenson, Lynne W.

AU - Van Veldhuisen, Dirk J.

AU - Zannad, Faiez

AU - Anker, Stefan D.

AU - Rhodes, Andrew

AU - McMurray, John J V

AU - Filippatos, Gerasimos

PY - 2010/5/1

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