PMID- 31051151 OWN - NLM STAT- MEDLINE DCOM- 20200302 LR - 20200302 IS - 1555-7162 (Electronic) IS - 0002-9343 (Linking) VI - 132 IP - 9 DP - 2019 Sep TI - Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial. PG - e679-e692 LID - S0002-9343(19)30350-X [pii] LID - 10.1016/j.amjmed.2019.04.010 [doi] AB - 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. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Simonavicius, Justas AU - Simonavicius J AD - Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: j.simonavicius@gmail.com. FAU - Sanders van-Wijk, Sandra AU - Sanders van-Wijk S AD - Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. FAU - Rickenbacher, Peter AU - Rickenbacher P AD - Department of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland. FAU - Maeder, Micha T AU - Maeder MT AD - Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland. FAU - Pfister, Otmar AU - Pfister O AD - Department of Cardiology, University Hospital Basel, Basel, Switzerland. FAU - Kaufmann, Beat A AU - Kaufmann BA AD - Department of Cardiology, University Hospital Basel, Basel, Switzerland. FAU - Pfisterer, Matthias AU - Pfisterer M AD - Department of Cardiology, University Hospital Basel, Basel, Switzerland. FAU - Celutkiene, Jelena AU - Celutkiene J AD - Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania. FAU - Puronaite, Roma AU - Puronaite R AD - Department of Information Systems, Centre of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Clinic of Cardiac and Vascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania. FAU - Knackstedt, Christian AU - Knackstedt C AD - Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. FAU - van Empel, Vanessa AU - van Empel V AD - Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands. FAU - Brunner-La Rocca, Hans-Peter AU - Brunner-La Rocca HP AD - Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiology, University Hospital Basel, Basel, Switzerland. LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20190430 PL - United States TA - Am J Med JT - The American journal of medicine JID - 0267200 RN - 0 (Peptide Fragments) RN - 0 (Sodium Potassium Chloride Symporter Inhibitors) RN - 0 (pro-brain natriuretic peptide (1-76)) RN - 114471-18-0 (Natriuretic Peptide, Brain) SB - IM CIN - Am J Med. 2020 Jun;133(6):e329. PMID: 32014285 CIN - Am J Med. 2020 Jun;133(6):e330-e332. PMID: 32532381 MH - Age Factors MH - Aged MH - Dyspnea, Paroxysmal/mortality MH - Edema/*mortality MH - Female MH - Glomerular Filtration Rate MH - Heart Failure/drug therapy/*mortality MH - Heart Rate MH - Hepatomegaly/mortality MH - Hospitalization/statistics & numerical data MH - Humans MH - Male MH - Natriuretic Peptide, Brain/blood MH - Peptide Fragments/blood MH - Prognosis MH - Severity of Illness Index MH - Sex Factors MH - Sodium Potassium Chloride Symporter Inhibitors/administration & dosage OTO - NOTNLM OT - Congestion OT - Heart failure OT - Loop diuretic OT - Prognosis OT - Signs OT - Symptoms EDAT- 2019/05/06 06:00 MHDA- 2020/03/03 06:00 CRDT- 2019/05/04 06:00 PHST- 2019/03/20 00:00 [received] PHST- 2019/04/06 00:00 [revised] PHST- 2019/04/08 00:00 [accepted] PHST- 2019/05/06 06:00 [pubmed] PHST- 2020/03/03 06:00 [medline] PHST- 2019/05/04 06:00 [entrez] AID - S0002-9343(19)30350-X [pii] AID - 10.1016/j.amjmed.2019.04.010 [doi] PST - ppublish SO - Am J Med. 2019 Sep;132(9):e679-e692. doi: 10.1016/j.amjmed.2019.04.010. Epub 2019 Apr 30.