Prevalence and prognostic impact of subclinical venous congestion in patients hospitalized for acute heart failure.

Abstract

Background: Congestion is a major cause of hospitalisation in patients with heart failure (HF) and the persistence of congestive signs at discharge is a robust predictor of early readmission. Currently, there is increasing interest in the comprehensive assessment of subclinical congestion, as it can increase residual risk in individuals who appear to be euvolemic. Our aim was to investigate the prevalence and prognostic impact of subclinical venous congestion assessed by ultrasound.

Methods: This is a two-centre, prospective observational study. Patients admitted for HF between June 2021 and March 2023 were selected. Clinical (physical examination) and subclinical venous congestion [Venous Excess Ultrasound score (VExUS)] were assessed. The prognostic impact was assessed through a composite endpoint of death from any cause, HF readmissions, or unscheduled visits requiring intravenous diuretic administration at 6-month follow-up.

Results: 120 patients were included (62% male, mean age 75±15 years). Congestion parameters decreased during hospitalisation but tended to worsen at the first outpatient visit. At discharge, 24% showed subclinical venous congestion. This group had a significantly higher incidence of adverse outcomes, comparable to those with overt clinical congestion. Subclinical congestion was an independent predictor of the composite endpoint (HR 2.84; 95% CI: 1.01-8.01, p value=0.048) after adjustment for age, chronic kidney disease, NYHA class at admission, and NT-proBNP level at discharge.

Conclusions: Clinical and subclinical congestion decreased during hospitalisation but worsened shortly after discharge. A quarter of patients had residual venous congestion which was associated with a worse prognosis at 6 months.