Clinical congestion patterns in patients with advanced heart failure: an analysis of the HELP-HF Registry.

**Kongestionsmönster kan förutsäga dödlighet vid framskriden hjärtsvikt** En klassificering av vätskeöverbelastning vid framskriden hjärtsvikt identifierar patientgrupper med väsentligt olika prognoser — kunskap som kan stärka riskstratifiering i klinisk vård och påverka behandlingsintensitet. HELP-HF-registret följde 1149 patienter med högriskhjärtsvikt. Forskarna kategoriserade fyra kongestionsmönster: ingen överbelastning (28,9 %), perifär ödem (28,5 %), lungödem (12,5 %) och kombinerad kongestion (30,1 %). Efter ett år varierade mortalitet eller första hjärtsviktshospitalisering från 36,5 % till 47,7 % mellan grupperna. Lungödem och kombinerad kongestion ökade både död och hjärtsviktshospitalisering oberoende av andra faktorer. Perifär kongestion kopplades främst till återinläggningar. Sjukhus och regionvård kan implementera denna enkla bedömning vid varje patientkontakt för att identifiera vilka som behöver aggressivare vätskebehandling och täta uppföljningar.

BACKGROUND: The impact of different clinical congestion phenotypes in advanced heart failure (HF) has not been fully investigated. We aimed to evaluate congestion patterns in patients with advanced heart failure HF (AdvHF). METHODS: The HELP-HF registry enrolled consecutive patients with HF and at least one high-risk 'I NEED HELP' marker. Patients' characteristics and outcomes were compared across different clinically defined congestion patterns. The primary endpoint was the composite of all-cause mortality or first HF hospitalization. RESULTS: A total of 1149 patients were included (mean age 75.1 ± 11.5 years, median left ventricular ejection fraction 35%). Among them, 332 patients (28.9%) had no sign of congestion, 327 (28.5%) had peripheral congestion, 144 (12.5%) had pulmonary congestion and 346 (30.1%) had both peripheral and pulmonary congestion. The 1-year rate of the primary endpoint progressively increased across these four groups (36.5%, 44%, 45.8% and 47.7%; P = 0.0002), as did all-cause and cardiovascular (CV) mortality (both P < 0.0001). Compared with no congestion, pulmonary congestion and combined congestion were independently associated with the primary endpoint [adjusted hazard ratio (aHR) 1.60, 95% confidence interval (CI) 1.15-2.21; and aHR 1.36, 95% CI 1.05-1.77, respectively], as well as with all-cause and CV mortality. Peripheral congestion was independently associated with an increased risk of recurrent HF hospitalizations (aHR 1.37, 95% CI 1.01-1.86), whereas pulmonary congestion and combined congestion were not. CONCLUSIONS: In our real-world multicentre registry enrolling patients with markers of AdvHF, a simple bedside congestion classification identified distinct clinical characteristics and stratified the risk of clinical events.