The Art and Science of Congestion Diagnosis and Management in Heart Failure

DiagnosisHeart failure (HF) is a significant clinical burden contributing to many deaths and hospitalisations worldwide, and congestion lies at its core, both as the chief culprit of acute decompensation events and a key therapeutic target.1,2 In this Cardiac Failure Review special collection, four complementary, state-of-the-art papers explore congestion from unique perspectives: pathophysiology, biomarkers, device-based strategies and the challenge of residual congestion.This editorial synthesises insights gained from these papers and places them in the context of contemporary clinical practice, including the latest European Society of Cardiology (ESC) guidelines on HF and the ESC's 2023 focused update, as well as recent trial findings.3,4 The central message we hope to convey is that congestion is not merely a phenomenon of excess water in a patient with HF, but instead is a complex, multifaceted process that requires nuanced assessment and a multimodal diagnostic and therapeutic approach.