Congestion in acute heart failure trials and registries: a systematic review

[摘要] Introduction: The term “congestion” is used to describe a broad range of clinical presentations. Congestion is a variably understood and assessed entity. Patients develop a mixture of central (pulmonary) and/or peripheral (non-pulmonary) symptoms of congestion. These are likely to have different pathophysiological mechanisms.The presence of subclinical congestion is an independent risk factor for early re-hospitalisation and morbidity. Novel techniques to assess congestion have been developed, but their clinical role is not yet established.Methods: I performed two systematic reviews of acute heart failure (AHF) trials and registries from Jan 1, 2001 to Dec 31, 2018 on EMBASE and MEDLINE to determine the methods and techniques used to assess and grade congestion. The search terms utilised were “acute heart failure”, “decompensated heart failure” and “hospitalized heart failure”. The minimum enrolment numbers were 180 patients for randomised trials and 2,000 patients for registries.Results: 18 major acute heart failure registries and 21 major trials were analysed. There are no standardised methods for assessing central or peripheral congestion.Acute heart failure trials preferentially recruited patients with pulmonary congestion (manifesting as dyspnoea at rest). In 6 of 8 trials with available data, this was mandatory for 100% of patients. By contrast, for large registry trials this rate ranged from 34 to 73%. Dyspnoea on exertion was a more predominant presentation (61 to 95%). With the exception of a chest X-ray, no trial or registry routinely utilised non-invasive (e.g. lung ultrasound) or invasive (e.g. right heart catheterisation) techniques to objectively and systematically quantify either congestion on recruitment or congestion on discharge.Conclusion: Congestion is variably assessed and defined.Internationally agreed definitions of the presence and severity of congestion are required.These definitions should include conventional symptoms and signs as well as newer methods of assessing congestion.Trials of treatments for central or peripheral congestion may have different inclusion criteria.

[发布机构] University:University of Glasgow;Department:Institute of Cardiovascular and Medical Sciences

[关键词] Acute heart failure, congestion, pulmonary congestion.