Pulmonary B-lines at discharge were the strongest predictor of mortality or heart failure readmission (HR 3.50, 95% CI 1.41–8.72) in patients hospitalized for acute heart failure.
Does the presence of subclinical congestion assessed via non-invasive markers predict adverse outcomes in adults hospitalized for heart failure?
Subclinical congestion is common in heart failure patients at discharge despite apparent clinical euvolemia, and non-invasive markers like pulmonary B-lines strongly predict 6-month mortality and readmission.
Absolute Event Rate: 0% vs 0%
Background/Objectives: Congestion is a hallmark of heart failure (HF) and a major determinant of outcomes. Non-invasive tools enable detection of subclinical congestion, but their correlation and prognostic relevance remain incompletely defined. The present study aimed to assess the prevalence, evolution, interrelationships, and prognostic impact of clinical and subclinical congestion markers in patients hospitalized for HF. Methods: This single-centre, prospective cohort study included adults admitted with HF who underwent serial evaluations at admission, 72 h, pre-discharge, early outpatient follow-up and at 6 months. Clinical congestion was assessed using a standardized physical examination score. Subclinical congestion was evaluated using lung ultrasound (LUS), Venous Excess Ultrasound Score (VExUS), and Remote Dielectric Sensing (ReDS). Patients were classified according to the presence of clinical and/or subclinical congestion at discharge. The primary endpoint was a composite of all-cause mortality, HF readmission, or unscheduled visits requiring intravenous diuretics within six months. Results: Ninety-four patients (mean age 74 ± 11 years, 68% male) were included. While clinical congestion improved significantly during hospitalization, approximately 30% of patients remained clinically congested at discharge. Among clinically euvolemic patients, only 47% showed no evidence of subclinical congestion. Correlations between congestion markers were weak to moderate, suggesting complementary pathophysiological information. At discharge, pulmonary B-lines were the strongest predictor of the composite endpoint (hazard ratio HR 3.50, 95% CI 1.41–8.72), followed by clinical congestion (HR 2.67, 95% CI 1.13–6.30). Patients with clinical and subclinical congestion exhibited lower event-free survival. Conclusions: Subclinical congestion is common despite apparent clinical euvolemia and is associated with worse outcomes. Integrating clinical assessment with non-invasive congestion markers may improve post-discharge risk stratification in HF.
Lozano-Jiménez et al. (Sun,) reported a other. Pulmonary B-lines at discharge were the strongest predictor of mortality or heart failure readmission (HR 3.50, 95% CI 1.41–8.72) in patients hospitalized for acute heart failure.