Physical Assessment of Congestion and Perfusion Status in Heart Failure.

Abstract

Background: Clinical profiles based on congestion and perfusion are fundamental to the management of patients with heart failure (HF), but the standard assessment has been underutilized in clinical practice, due in part to its complexity. This study investigated whether congestion and perfusion status by physical examination, such as high jugular venous pressure (JVP) and peripheral cold sensation, would be informative in this context.

Methods: This prospective study consisted of 257 patients who were admitted for the treatment of HF. A body-to-peripheral temperature gradient and the presence or absence of peripheral cold sensation were assessed before discharge. JVP was considered high if visible pulsation of the internal jugular vein was observed in the seated position at rest or with inspiration, and categorized as wet. The primary outcome was a composite of all-cause death and hospitalization for worsening HF.

Results: A total of 132 patients (51.3%) were classified as cold on the peripheral sensation, with a higher temperature gradient (9.0 ± 1.8ºC) than patients without peripheral cold sensation (4.8 ± 1.7ºC, p <0.01). On JVP assessment, 54 patients (21.0%) were classified as wet. During a mean follow-up period of 446 ± 280 days, 109 patients experienced a primary outcome event. The presence of peripheral cold sensation and wet condition were associated with a higher incidence of the primary outcome (hazard ratio, 1.70 and 1.62; 95% confidence interval, 1.14 to 2.52 and 1.04 to 2.52; both p <0.01, respectively). The status of congestion and perfusion based on the standard classification and our simple physical method using peripheral sensation and JVP assessment showed similar trends in the incidence of the primary outcome at one year.

Conclusions: Physical assessment of congestion and perfusion status based on the presence or absence of peripheral cold sensation and wet condition by JVP assessment was practical and useful for the risk stratification of patients with HF.