Author + information
- Received January 30, 2017
- Revision received September 15, 2017
- Accepted September 26, 2017
- Published online March 26, 2018.
- Nicolas Girerd, MD, PhDa,
- Marie-France Seronde, MD, PhDb,
- Stefano Coiro, MDc,
- Tahar Chouihed, MDa,d,
- Pascal Bilbault, MD, PhDe,
- François Braun, MDf,
- David Kenizou, MDg,
- Bruno Maillier, MDh,
- Pierre Nazeyrollas, MD, PhDi,
- Gérard Roul, MD, PhDj,
- Ludivine Fillieux, PharmDk,
- William T. Abraham, MDl,
- James Januzzi Jr., MDm,
- Laurent Sebbag, MD, PhDn,
- Faiez Zannad, MD, PhDa,
- Alexandre Mebazaa, MD, PhDo,
- Patrick Rossignol, MD, PhDa,∗ (, )
- on behalf of INI-CRCT, Great Network, and the EF-HF Group
- aINSERM, Centre d’Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
- bService de cardiologie CHU de Besançon, EA 3920, Unité INSERM 942 CHU Lariboisière, Paris, France
- cDivision of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
- dEmergency Department, CHU de Nancy, France
- eEmergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France and EA 7293 Stress vasculaire, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
- fStructures de Médecine d'Urgence, Centre Hospitalier Régional, Hôpital de Mercy, Metz, France
- gService de cardiologie, Hôpital Emile Muller, Mulhouse, France
- hService de cardiologie, Centre hospitalier de Troyes, Anatole, France
- iCentre de Recherche et d’Investigation Clinique, Service de Cardiologie, CHU de Reims, Reims, France
- jPôle d'activité médico-chirurgicale cardiovasculaire Nouvel Hôpital Civil, Strasbourg, France and Unité d’insuffisance cardiaque, Centre de compétence des cardiomyopathies
- kNovartis Pharma SAS, Rueil-Malmaison, France
- lDavis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio
- mDivision of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- nHospices Civils de Lyon, Hôpital Louis Pradel, Pôle Médico-Chirurgical de Transplantation Cardiaque Adulte, Bron, France
- oDepartment of Anesthesiology, Critical Care and Burn Unit, St. Louis Hospital, University Paris, UMR-S942, INSERM and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network Nancy, GREAT Network, Paris, France
- ↵∗Address for correspondence:
Prof. Patrick Rossignol, Centre d’Investigations Cliniques-INSERM CHU de Nancy, Institut lorrain du Cœur et des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500 Vandoeuvre Lès Nancy, France.
Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations. Electronic alert systems and communication platforms are emerging that could be used to facilitate patient home monitoring that identifies congestion from heart failure decompensation at an earlier stage. This paper describes the role of congestion detection methods at key stages of patient care: pre-admission, admission to the emergency department, in-hospital management, and lastly, discharge and continued monitoring in the community. The multidisciplinary working group, which consisted of cardiologists, emergency physicians, and a nephrologist with both clinical and research backgrounds, reviewed the current literature regarding the various scores, tools, and tests to detect and quantify congestion. This paper describes the role of each tool at key stages of patient care and discusses the advantages of telemedicine as a means of providing true integrated patient care.
Drs. Girerd, Seronde, Coiro, Chouihed, Bilbaut, Braun, Kenizou, Mailleri, Nazeyrollas, and Rossignol received board fees from Novartis. Drs. Rossignol, Zannad, Mebazaa, Chouihed, and Girerd are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d'Avenir” programme (ANR-15-RHU-0004). Dr. Fillieux is an employee of Novartis. Dr. Abraham is the co-principal investigator (PI) of the CHAMPION trial; a member of Steering Committees of the REDUCEhf and COMPASS-HF trials; is a PI of HOMEOSTASIS trial; and has received consulting fees from St. Jude Medical and Medtronic. Dr. Januzzi has received grant support from Siemens, Singulex, and Prevencio; consulting income from Roche Diagnostics, Critical Diagnostics, Sphingotec, Phillips, and Novartis; and participates in clinical endpoint committees/data safety monitoring boards for Novartis, Amgen, Janssen, and Boehringer Ingelheim. Dr. Zannad is a compensated board member for Boston Scientific; a consultant for Boston Scientific, CVRx, LivaNova, Janssen, Bayer, Pfizer, Novartis, Resmed, Amgen, Quantum Genomics, Takeda, General Electric, Boehringer, Relypsa, ZS Pharma, AstraZeneca, and Roche Diagnostics; and is a compensated speaker with Pfizer and AstraZeneca. Dr. Mebaza has received speaker honoraria from The Medicines Company, Novartis, Orion, Roche, Servier, and Vifor Pharma; and has received fees as member of advisory board and/or steering committee from Cardiorentis, The Medicine Company, Adrenomed, MyCartis, and Critical Diagnostics. Dr. Rossignol is a consultant for Bayer, Relypsa, AstraZeneca, Stealth Peptides, Fresenius, Vifor Fresenius Medical Care Renal Pharma, and CTMA; has received lecture fees from CVRx from Relypsa; and is the cofounder of CardioRenal Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
John R. Teerlink, MD, served as Guest Editor for this paper.
- Received January 30, 2017.
- Revision received September 15, 2017.
- Accepted September 26, 2017.
- Central Illustration
- Clinical Tools for Evaluating Congestion
- Circulating Biomarkers for Evaluating Congestion
- Imaging Tools for Evaluating Congestion
- Pressure and Impedance-Based Tools
- Applying the Right Tool for Each Stage of Patient Management
- Integrating These Tools into Heart Failure Networks: The Role of Telemedicine
- Gaps in Evidence and Unmet Needs
- A Roadmap for the Clinical Validation of Congestion Variables as Actionable Biomarkers for HF Management