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 - Tập 12 Số 5 - Trang 423-433 - 2010
Mihai Gheorghiade1, Ferenc Folláth2, Piotr Ponikowski3, Jeffrey H. Barsuk4, John E. Blair5, John G.F. Cleland6, Kenneth Dickstein7,8, Mark H. Drazner9, Gregg C. Fonarow10, Tiny Jaarsma11, Guillaume Jondeau12, J. López Sendón13, Alexander Mebazaa14,14, Marco Metra15, Markku S. Nieminen16, Peter S. Pang17, Petar Seferović18, Lynne Warner Stevenson19, Dirk J. van Veldhuisen20, Faı̈ez Zannad21, Stefan D. Anker21, Andrew Rhodes22, John J.V. McMurray23, Gerasimos Filippatos24
1Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
2Department of Medicine, University Hospital, Zürich, Switzerland
3Department of Cardiology, Military Hospital, Wroclaw, Poland
4Division of Hospital Medicine, Northwestern University Feinberg School of Medicine , Chicago, IL, USA
5Department of Cardiology, Wilford Hall Medical Center, San Antonio, TX, USA
6Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Hull, UK
7Institute of Internal Medicine, University of Bergen, Bergen, Norway
8Stavanger University Hospital, Stavanger, Norway
9University of Texas Southwestern Medical Center, Dallas, TX, USA;
10Division of Cardiology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
11Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
12Service de Cardiologie, Hôpital Bichat, Paris, France
13Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
14U942 INSERM University Paris Diderot Paris France
15Department of Cardiology, University of Brescia, Brescia, Italy
16Department of Medicine, Section of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
17Department of Emergency Medicine and Center for Cardiovascular Quality and Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
18Department of Cardiology II, University Institute for Cardiovascular Diseases, Belgrade, Serbia
19Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
20Henri Poincaré University of Nancy Nancy France
21Department of Cardiology Campus Virchow‐Klinikum, Charité Universitätsmedizin Berlin Germany
22Department of Intensive Care Medicine, St George’s Hospital, London, UK
23British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK
24Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Rimini 1, 12461 Haidari, Athens, Greece

Tóm tắt

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 prior to 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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European Journal of Heart Failure

Tập 12 Số 5

423-433

Thông tin tác giả