Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey

JACC Heart Fail. 2018 Apr;6(4):273-285. doi: 10.1016/j.jchf.2017.09.023. Epub 2017 Dec 6.


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.

Keywords: biomarkers; congestion; heart failure; lung ultrasound; natriuretic peptides; plasma volume.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aftercare
  • Disease Progression
  • Dyspnea / diagnosis
  • Dyspnea / etiology
  • Echocardiography
  • Edema, Cardiac / diagnosis
  • Edema, Cardiac / etiology
  • Emergency Medical Services
  • Emergency Service, Hospital
  • Heart Failure / blood
  • Heart Failure / complications
  • Heart Failure / diagnosis*
  • Hospitalization
  • Humans
  • Lung / diagnostic imaging
  • Natriuretic Peptide, Brain / blood
  • Patient Discharge
  • Peptide Fragments / blood
  • Plasma Volume
  • Prognosis
  • Pulmonary Edema / diagnostic imaging
  • Pulmonary Edema / etiology
  • Telemedicine
  • Vena Cava, Inferior / diagnostic imaging
  • Water-Electrolyte Balance
  • Weight Gain


  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain