Congestion in chronic systolic heart failure is related to renal dysfunction and increased mortality

Aims To investigate the relationship between signs and symptoms of congestion, renal impairment and outcome in chronic heart failure (CHF) patients. Methods and results The Cardiac Insufficiency Bisoprolol Study II included 2647 NYHA class III/IV CHF patients. Congestion was estimated by the presence of elevated jugular venous pressure, orthopnoea, ascites, or oedema. Glomerular filtration rate (eGFR) was estimated using the simplified modification of diet in renal disease (sMDRD) formula. The main outcome consisted of all-cause mortality. Mean age was 61 +/- 11 years, 80% of patients were male, and mean eGFR was 77 +/- 31 mL/min/1.73 m(2). A total of 1234 (47%) patients had at least one sign, and 10% of patients had more than three signs of congestion. Mean eGFR was lower in patients with signs of congestion (75 +/- 30 vs. 79 +/- 31 mL/min/1.73 m(2), P<0.001). In multivariable analysis, signs of congestion remained independently related to eGFR (P = 0.012). Mortality rates almost doubled from no signs to three or more signs of congestion (11 vs. 20%, respectively, P<0.0001). Patients with any signs of congestion also had a worse outcome. Adjusted hazard ratio was 1.42 (1.14-1.77), P<0.01 for mortality and 1.21 (1.05-1.39), P<0.01 for the composite endpoint. Conclusion Signs and symptoms of congestion are associated with renal impairment and are independent determinants of prognosis in patients with CHF