Persistent congestion at first post-discharge heart failure clinic visit: prevalence, phenotypic characterization and quantification

Aims

Residual congestion after hospitalization for acute decompensated heart failure (ADHF) is common and is related to early post-discharge adverse outcomes.

Objective

To determine the prevalence, characterize and quantify residual congestion at the first post-discharge visit to a specialized heart failure unit (HFU).

Design: Retrospective, single-center observational study of consecutive patients attending a first visit at HFU after discharge for ADHF (hospital admission or emergency department with intravenous diuretic administration) during the first semester of 2025. Residual congestion was defined as the presence of any objective sign of congestion at physical examination (jugular venous distension, edema, pulmonary crackles), lung ultrasound (≥3 B-lines in any of 8 zones), or venous ultrasound (inferior vena cava -IVC- > 21mm or IVC colapsability <50%, or portal vein pulsatility >30%) or laboratory (NTproBNP or CA125>35). Congestion phenotypes were classified into four predefined groups: (1) pulmonary–intravascular congestion; (2) pulmonary–tissular; (3) systemic–intravascular, (4) systemic–tissular congestion. Baseline clinical characteristics, laboratory data, and echocardiographic parameters were collected. The degree of congestion was further quantified according to the ESC position paper on diuretics.

Results

A total of 252 patients (median age 67 years, 71% male) were visited after 16 [11-25] days post discharge. Residual congestion based on physical examination was found in 57 (22%) of patients at the first post-discharge visit. However, after a multimodal evaluation up to 169 patients (66%) had congestion. Pulmonary intravascular congestion was the most frequent phenotype (n=144, 71%), followed by pulmonary tissular (n=71, 28%) and systemic tissular (n=49, 21%). Mixed phenotypes were present in 82 patients (32%). Congestion severity was mild in 43%, moderate in 24%, and severe in 32% of patients.

Conclusions

Congestion was highly prevalent at a first HFU visit post AHF admission when assessed with a multimodal approach. Over 50% of patients had moderate to severe congestion and pulmonary intravascular congestion was the most freqüent congestion phenotype.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.