Heart failure & cardiomyopathiesSecondary analysis
Clinical Profiles and Prognostic Impact of Residual Intravascular and Tissue Congestion in Acute Heart Failure
- Secondary analysis of the PROTECT and RELAX-AHF-2 randomised trials
- index and replication cohorts
Authors' conclusion
Patients with intravascular RC had better diuretic responses and shorter hospital stays than those with tissue/combined RC, but worse outcomes than decongested patients.
Study context
- Population
- Patients with acute decompensated heart failure (ADHF) and congestion at admission (PROTECT and RELAX-AHF-2 trials)580 (37%) with residual congestion
- Participants
- 1,557 patients
- Comparison
- Residual congestion phenotypes at day 7/discharge vs decongested
- Intravascularn = 260
- Combinedn = 185
- Tissuen = 135
- Primary endpoint
- All-cause mortality
- Follow-up
- 180 days
Primary result
As reported in the abstract
180-day mortality
Each group vs decongestedHazard ratio (95% CI)
Intravascular
1.69(1.15–2.49)
Tissue
2.07(1.25–3.41)
Further findings
In-hospital diuretic response, length of stay, IV loop diuretic dose · during hospitalization
- Solely intravascular residual congestion (RC): greater diuretic responses, shorter stays and lower IV loop diuretic doses vs tissue or combined
- all p < 0.05
180-day mortality, RELAX-AHF-2 substudy (replication)
- Similar findings observed
- n = 476
Original publication
Clinical Profiles and Prognostic Impact of Residual Intravascular and Tissue Congestion in Acute Heart Failure. Eur J Heart Fail. Published 11 November 2025. doi:10.1002/ejhf.70091
Summarised from the published abstract; every number is checked against it