Prevalence of Pulmonary Edema in Acute Decompensated Heart Failure: A Systematic Review

Importance: Accurate and reliable assessment of pulmonary congestion is important for describing baseline characteristics and estimating acute decompensated heart failure (ADHF) patient risk in population studies. Objective: This systematic review aims to determine prevalence and methods of assessing pulmonary edema in studies enrolling ADHF patients. Methods: PubMed and Embase were searched from January 2009 to April 2019 to identify studies based on large heart failure registries. Prevalence of ADHF and methods of determining pulmonary edema were abstracted and summarized. The NIH Quality Assessment Tool was used for assessing risk of bias. Findings: Eight prospective, inpatient, large (N≥1000) heart failure registries were included; all were set in Europe or the US. Although most studies reported using either physical exam or chest radiography for assessment, specific criteria were not generally reported. The prevalence of pulmonary congestion among ADHF patients was imprecise and ranged from 3% to 74%. Conclusions and Relevance: Large ADHF registries are not consistent at measuring and reporting pulmonary congestion. Use of standardized methods could better estimate the prevalence of pulmonary edema among ADHF populations.