Prognostic Value of the Severity of Clinical Congestion in Patients Hospitalized for Decompensated Heart Failure: Findings From the Japanese KCHF Registry
Graphical Abstract
Section snippets
Population
The KCHF registry is a prospective, multicenter, observational cohort study, that is designed as an all-comer registry to capture recent trends in clinical characteristics, socioeconomic factors, management, and prognosis of patients with ADHF in a super-aging society in Japan.15, 16, 17 Therefore, the KCHF registry enrolled, without exclusion and regardless of left ventricular ejection fraction, all consecutive patients hospitalized for acute congestive HF between October 2014 and March 2016
Patient Characteristics
Among 3787 study patients, the median CCS on admission was 4 (IQR 3–6). We classified the study population into 3 groups according to CCS on admission (mild congestion group [CCS of ≤3]: 1263 patients [33%]; moderate congestion group [CCS of 4 or 5]: 1247 patients [33%]; and the severe congestion group [CCS of ≥6]: 1277 patients [34%)] (Fig. 1, 2A). Patients with a higher admission CCS were more likely to have a hypertensive heart disease as the etiology for HF (Table 1). The proportions of
Discussion
The KCHF registry provided the unique features of current clinical practice for HF in an era of a super-aging society in Japan. The present study confirmed that, in current clinical practice for HF in Japan, clinical congestion completely improved in 85% of patients during the median hospital stay of 16 days. Nevertheless, the severity of congestion on admission was related to long-term adverse outcomes. Patients with residual congestion had a markedly higher risk of postdischarge death and
Limitations
There are several limitations in the present study. We used a semiquantitative tool composed of physical signs and symptoms to assess clinical congestion. By using the same scale as that used previously, the present study provides a unique snapshot of a change in the congestion status in Japanese clinical practice. However, physical signs and symptoms are inherently subjective, prone to variation, and dependent on a physician's skills.33,34 Nevertheless, physical signs and symptoms remain the
Conclusions
In current Japanese clinical practice, 85% of patients were discharged with complete decongestion and the median hospitalization length of 16 days. Clinical congestion, both on admission and at discharge, was associated with clinical outcomes. The severity of congestion on admission was predictive of adverse outcomes, even in the absence of residual congestion.
Lay Summary
Congestion is a major therapeutic target in patients with heart failure. Clinical practice in Japan is characterized by a long hospital stay, which would facilitate extensive decongestion during hospitalization. The present study in a large contemporary cohort of Japanese patients with heart failure confirmed that clinical decongestion with complete relief of peripheral edema, jugular venous distension, and orthopnea was achieved in 85% of the patients during a median hospitalization length of
Declaration of Competing Interest
None declared.
Acknowledgments
The authors thank the staff of the KCHF study and the members of the participating centers.
References (35)
- et al.
The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries
J Am Coll Cardiol
(2014) Heart failure
JACC: Heart Failure
(2013)- et al.
Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure
Int J Cardiol
(2018) - et al.
The burden of congestion in patients hospitalized with acute decompensated heart failure
Am J Cardiol
(2019) - et al.
Integrative assessment of congestion in heart failure throughout the patient journey
JACC Heart Fail
(2018) - et al.
The role of the clinical examination in patients with heart failure
JACC Heart Fail
(2018) - et al.
Burden of heart failure signs and symptoms, prognosis, and response to therapy: the PARAGON-HF trial
JACC Heart Fail
(2021) - et al.
Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland
Eur J Heart Fail
(2017) - et al.
Acute heart failure congestion and perfusion status – impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA heart failure long-term registry
Eur J Heart Fail
(2019) - et al.
European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions
Eur J Heart Fail
(2016)