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Interaction between worsening renal function and persistent congestion in acute decompensated heart failure
Malak Wattad1, Wisam Darawsha1, Amir Solomonica1
1Department of Cardiology, Rambam Medical Center, Haifa, Israel.
The American Journal of Cardiology
|February 22, 2015
Summary
Worsening renal function (WRF) and persistent congestion in acute decompensated heart failure patients are linked to worse outcomes. This study found that the combination of WRF and persistent congestion significantly increases mortality risk.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Worsening renal function (WRF) and congestion are pathophysiologically linked in acute decompensated heart failure (ADHF).
- The combined effect of WRF and persistent congestion on clinical outcomes in ADHF patients requires further investigation.
Purpose of the Study:
- To investigate the interdependence between WRF and persistent congestion in ADHF patients.
- To determine the association of WRF and persistent congestion with mortality and heart failure readmission.
Main Methods:
- A cohort of 762 ADHF patients was studied.
- WRF was defined as a ≥0.3 mg/dl increase in serum creatinine; persistent congestion was defined as ≥1 sign of congestion at discharge.
- Primary endpoint was all-cause mortality; secondary endpoint was HF readmission, with a mean follow-up of 15 months.
Main Results:
- Persistent congestion was more frequent in patients with WRF (51.0%) than in those with stable renal function (26.6%).
- Both persistent congestion and WRF were significantly associated with increased mortality (p <0.0001).
- A significant interaction (p = 0.003) was observed between WRF and persistent congestion, with the highest mortality risk in patients experiencing both.
Conclusions:
- Persistent congestion is common in ADHF patients with WRF.
- The combination of persistent congestion and WRF significantly increases the risk of all-cause mortality in ADHF patients.
- Congestion poses a greater mortality risk when associated with WRF.
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