Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF).
Abstract
BACKGROUND: Congestion is the most frequent cause for hospitalization in acute decompensated
heart failure. Although decongestion is a major goal of acute therapy, it is unclear
how the clinical components of congestion (eg, peripheral edema, orthopnea) contribute
to outcomes after discharge or how well decongestion is maintained. METHODS AND RESULTS:
A post hoc analysis was performed of 496 patients enrolled in the Diuretic Optimization
Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal
Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trials during hospitalization
with acute decompensated heart failure and clinical congestion. A simple orthodema
congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points,
<2 pillows=0 points) and peripheral edema (trace=0 points, moderate=1 point, severe=2
points) at baseline, discharge, and 60-day follow-up. Orthodema scores were classified
as absent (score of 0), low-grade (score of 1-2), and high-grade (score of 3-4), and
the association with death, rehospitalization, or unscheduled medical visits through
60 days was assessed. At baseline, 65% of patients had high-grade orthodema and 35%
had low-grade orthodema. At discharge, 52% patients were free from orthodema at discharge
(score=0) and these patients had lower 60-day rates of death, rehospitalization, or
unscheduled visits (50%) compared with those with low-grade or high-grade orthodema
(52% and 68%, respectively; P=0.038). Of the patients without orthodema at discharge,
27% relapsed to low-grade orthodema and 38% to high-grade orthodema at 60-day follow-up.
CONCLUSIONS: Increased severity of congestion by a simple orthodema assessment is
associated with increased morbidity and mortality. Despite intent to relieve congestion,
current therapy often fails to relieve orthodema during hospitalization or to prevent
recurrence after discharge. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov.
Unique identifiers: NCT00608491, NCT00577135.
Type
Journal articleSubject
dyspneaedema
follow-up studies
heart failure
hospitalization
Acute Disease
Aged
Aged, 80 and over
Diuretics
Dyspnea
Edema
Female
Heart Failure
Hospitalization
Humans
Male
Middle Aged
Patient Discharge
Patient Readmission
Predictive Value of Tests
Randomized Controlled Trials as Topic
Recurrence
Remission Induction
Retrospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Weight Loss
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https://hdl.handle.net/10161/11021Published Version (Please cite this version)
10.1161/CIRCHEARTFAILURE.114.001957Publication Info
Lala, Anuradha; McNulty, Steven E; Mentz, Robert J; Dunlay, Shannon M; Vader, Justin
M; AbouEzzeddine, Omar F; ... Stevenson, Lynne W (2015). Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart
Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated
Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart
Failure (CARESS-HF). Circ Heart Fail, 8(4). pp. 741-748. 10.1161/CIRCHEARTFAILURE.114.001957. Retrieved from https://hdl.handle.net/10161/11021.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Kevin J. Anstrom
Professor of Biostatistics and Bioinformatics
My research interests include clinical trials, cost-benefit analysis, health economics,
semiparametric estimation, and medical informatics.
Adam David DeVore
Associate Professor of Medicine
Adam D. DeVore, MD, MHS
Dr. DeVore is a cardiologist and Assistant Professor of Medicine in the Department
of Medicine, Division of Cardiology, at Duke University School of Medicine. His clinical
interests include caring for patients and families with heart failure, including those
with left ventricular assist devices and heart transplants. He is involved in and
leads multiple large studies of patients with heart failure at both Duke University
Medical Center and the
Gary Michael Felker
Professor of Medicine
Adrian Felipe Hernandez
Professor of Medicine
Robert John Mentz
Associate Professor of Medicine
I am a cardiologist with a clinical and research interest in heart failure, including
advanced therapies such as cardiac transplantation and mechanical assist devices or
“heart pumps." I serve our group as Chief of the Heart Failure Section. I became
a heart failure cardiologist in order to help patients manage their chronic disease
over many months and years. I consider myself strongly committed to compassionate
patient care with a focus on quality of life and patient preference.<br
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
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