Evolution of congestion during post-discharge follow-up in a heart failure unit
R Mora Molero, C Moliner, P Fluvia, A Armengou, A Hurtado, M Berenguel, N Coma, I Rovira, S Habbab, L Garcia, A FortAbstract
Background/Introduction
Residual congestion after acute decompensated heart failure (ADHF) has been related with adverse short term outcomes. Although decongestion is a central therapeutic goal, the trajectory of congestion resolution during early ambulatory follow-up remains poorly described.
Purpose
To describe the evolution of congestion during early post-discharge follow-up in a heart failure unit (HFU), characterize and quantify congestion resolution and persistence over time.
Methods
We conducted a retrospective, single-center cohort study including patients discharged after hospitalization or emergency department treatment for ADHF who attended a first post-discharge visit at a HFU during the first semester of 2025. Congestion was assessed at the first visit and at 3–6 months using a multimodal approach including physical examination, biomarkers, lung ultrasound, and venous ultrasound. Congestion was phenotyped according to anatomical compartment (pulmonary vs systemic) and volume distribution (intravascular vs tissular), and severity was graded using ESC diuretics 2019 document. Changes in pharmacological therapy and functional status were recorded.
Results
Among 141 patients with paired evaluations, the prevalence of any congestion significantly decreased from 71% at the first visit to 39% at 3–6 months (p<0.01). Severe congestion declined from 32% to 13% (p<0.01), with a parallel shift toward mild congestion (36% to 60%). Pulmonary intravascular congestion decreased from 69% to 33% (p<0.01) and pulmonary tissular congestion from 26% to 12% (p<0.01), while systemic tissular congestion declined from 23% to 10% (p<0.01); changes in systemic intravascular congestion were not significant (14% to 9%, p=0.16). NT-proBNP levels decreased from a median of 1618 [812-3572] to 597 [275-1482] pg/mL (p<0.01). Loop diuretic use declined from 65% to 41% (p<0.01).
Conclusion(s)
During early post-discharge follow-up, congestion burden and severity substantially decrease, predominantly driven by improvements in pulmonary and tissular compartments. However, a significant proportion of patients remain moderately to severely congested. Renal dysfunction and continued need for loop diuretics identify patients at higher risk of persistent congestion, underscoring the importance of repeated, multimodal congestion assessment to guide individualized management in heart failure units.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.