Advances in Congestion Assessment in Decompensated Heart Failure

Congestion is a typical clinical feature of acute decompensated heart failure (ADHF), causing symptoms and unplanned hospitalisation. Suboptimal decongestion during admission and residual congestion at hospital discharge contribute to adverse effects. Accurate assessment of congestion is crucial in guiding response to diuretic treatment, achieving euvolaemia and preventing early rehospitalisation, which accelerates cardiac dysfunction and increases the risk of mortality. Traditional fluid assessment methods, including physical examination and imaging, are often not adequate to assess congestion. Comorbidities, such as obesity (BMI >30), further limit the accuracy of diagnostic tools including echocardiography, radiography, and biomarkers such as N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP). This review explores traditional and emerging methods for evaluating congestion in ADHF and assesses their role in enhancing the clinical management of various congestion phenotypes.