Prognostic Value of the Severity of Clinical Congestion in Patients Hospitalized for Decompensated Heart Failure: Findings From the Japanese KCHF Registry.
Autor: | Aida K; Cardiovascular center, Osaka Red Cross Hospital, Osaka, Japan., Nagao K; Cardiovascular center, Osaka Red Cross Hospital, Osaka, Japan., Kato T; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: tkato75@kuhp.kyoto-u.ac.jp., Yaku H; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Morimoto T; Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan., Inuzuka Y; Department of Cardiovascular Medicine, Shiga Medical Center for Adult, Shiga, Japan., Tamaki Y; Division of Cardiology, Tenri Hospital, Nara, Japan., Yamamoto E; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Yoshikawa Y; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Kitai T; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan., Taniguchi R; Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan., Iguchi M; National Hospital Organization Kyoto Medical Center, Kyoto, Japan., Kato M; Mitsubishi Kyoto Hospital, Kyoto, Japan., Takahashi M; Shimabara Hospital, Kyoto, Japan., Jinnai T; Japanese Red Cross Otsu Hospital, Shiga, Japan., Kawai T; Kishiwada City Hospital, Osaka, Japan., Komasa A; Kansai Electric Power Hospital, Osaka, Japan., Nishikawa R; Shizuoka General Hospital, Shizuoka, Japan., Kawase Y; Kurashiki Central Hospital, Okayama, Japan., Morinaga T; Kokura Memorial Hospital, Fukuoka, Japan., Su K; Japanese Red Cross Wakayama Medical Center, Wakayama, Japan., Kawato M; Nishikobe Medical Center, Hyogo, Japan., Seko Y; Kitano Hospital, Osaka, Japan., Inada T; Cardiovascular center, Osaka Red Cross Hospital, Osaka, Japan., Inoko M; Kitano Hospital, Osaka, Japan., Toyofuku M; Japanese Red Cross Wakayama Medical Center, Wakayama, Japan., Furukawa Y; Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan., Nakagawa Y; Division of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan., Ando K; Kokura Memorial Hospital, Fukuoka, Japan., Kadota K; Kurashiki Central Hospital, Okayama, Japan., Shizuta S; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Ono K; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Sato Y; Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan., Kuwahara K; Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan., Ozasa N; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Kimura T; Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. |
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Jazyk: | angličtina |
Zdroj: | Journal of cardiac failure [J Card Fail] 2023 Aug; Vol. 29 (8), pp. 1150-1162. Date of Electronic Publication: 2023 Jan 21. |
DOI: | 10.1016/j.cardfail.2023.01.003 |
Abstrakt: | Background: Congestion is a leading cause of hospitalization and a major therapeutic target in patients with heart failure (HF). Clinical practice in Japan is characterized by a long hospital stay, which facilitates more extensive decongestion during hospitalization. We herein examined the time course and prognostic impact of clinical congestion in a large contemporary Japanese cohort of HF. Methods and Results: Peripheral edema, jugular venous pressure, and orthopnea were graded on a standardized 4-point scale (0-3) in 3787 hospitalized patients in a Japanese cohort of HF. Composite Congestion Scores (CCS) on admission and at discharge were calculated by summing individual scores. The primary outcome was a composite of all-cause death or HF hospitalization. The median admission CCS was 4 (interquartile range, 3-6). Overall, 255 patients died during the median hospitalization length of 16 days, and 1395 died or were hospitalized for HF over a median postdischarge follow-up of 396 days. The cumulative 1-year incidence of the primary outcome increased at higher tertiles of congestion on admission (32.5%, 39.3%, and 41.0% in the mild [CCS ≤3], moderate [CCS = 4 or 5], and severe [CCS ≥6] congestion groups, respectively, log-rank P < .001). The adjusted hazard ratios of moderate and severe congestion relative to mild congestion were 1.205 (95% confidence interval [CI], 1.065-1.365; P = .003) and 1.247 (95% CI, 1.103-1.410; P < .001), respectively. Among 3445 patients discharged alive, 85% had CCS of 0 (complete decongestion) and 15% had a CCS of 1 or more (residual congestion) at discharge. Although residual congestion predicted a risk of postdischarge death or HF hospitalization (adjusted hazard ratio, 1.314 [1.145-1.509]; P < .001), the admission CCS correlated with the risk of postdischarge death or HF hospitalization, even in the complete decongestion group. No correlation was observed for postdischarge death or HF hospitalization between residual congestion at discharge and admission CCS (P for the interaction = .316). Conclusions: In total, 85% of patients were discharged with complete decongestion in Japanese clinical practice. Clinical congestion, on admission and at discharge, was of prognostic value. The severity of congestion on admission was predictive of adverse outcomes, even in the absence of residual congestion. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02334891 (NCT02334891) https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000017241 (UMIN000015238). Competing Interests: Declaration of Competing Interest None declared. (Copyright © 2023 Elsevier Inc. All rights reserved.) |
Databáze: | MEDLINE |
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