[Rethinking congestion in patients with heart failure]

Lower-limb oedema and weight gain remain key components in the assessment of congestion in heart failure and continue to guide clinical decision-making. However, they only imperfectly reflect a complex pathological process involving interactions between the vascular and interstitial compartments, venous capacitance, and lymphatic drainage. Congestion extends beyond simple tissue fluid accumulation or weight gain and includes changes in vascular pressures and volumes that may be dissociated from one another and difficult to detect clinically. This dissociation may lead to diagnostic bias and overinterpretation of visible signs. An integrated approach to congestion therefore appears necessary to improve patient assessment and management.