Impact of Decongestion on Mortality of Acute Decompensated Heart Failure

Introduction: Decongestion is related to improved clinical outcomes in patients with heart failure (HF). Worsening of renal function (WRF) is sometimes accompanied by the treatment for decongestion. Methods: 154 consecutive patients admitted with their first presentation of acute decompensated HF were enrolled. We investigated the prognostic impact of markers for decongestion, including a decrease in body weight and a hemoconcentration defined as an increase in hemoglobin, as well as the presence of WRF, during the initial 3 days after admission. Results: When divided by the median of the decrease in body weight (1.8 kg per 3 days), the difference in 1-year mortality did not reach statistical significance, but the duration of hospitalization was shorter in the aggressive decongestion group (20.8 and 30.7 days, P = .034). Patients who had WRF without hemoconcentration had worse prognosis in the aggressive decongestion group (P = .009); whereas neither WRF nor hemoconcentration was associated with 1-year mortality in the other group (P = .913). If we exclude patients who had WRF without hemoconcentration, the difference in 1-year mortality between the two groups became significant (P = .026). Conclusions: WRF due to aggressive decongestion did not have worse effect if accompanied by hemoconcentration. Accomplishment of decongestion in the initial 3 days can be a simple and potent marker for improved outcome of HF.