Heart failure & cardiomyopathiesMeta-analysis
Clinical profiles to guide decongestion in acute heart failure
- Post-hoc pooled analysis of DOSE-AHF and ROSE-AHF
- serial congestion assessment and NT-proBNP at baseline and 72 hours
- Four 72-hour profiles were prespecified
Authors' conclusion
Integrating DR with RC at 72 hours identified 4 clinical profiles associated with 90-day risk. In the absence of a universally accepted decongestion target, these findings may help contextualize early treatment response and should be prospectively validated before guiding therapy.
Study context
- Population
- Patients with acute heart failurepatients (median age 69 [IQR: 60–79] years, 73% male)
- Participants
- 636 patients
- Comparison
- Integrating diuretic resistance (DR) with residual congestion (RC) at 72 hours; four 72-hour profiles, using RC-/low DR as reference
- Outcome
- 90-day composite of death, rehospitalization, or Emergency Department visit
- Follow-up
- Median 56 (34-62) days
Pooled result
As reported in the abstract
- RC+/low DR vs RC-/low DR
- higher risk 1.5-fold
- RC-/high DR vs RC-/low DR
- higher risk 1.8-fold
- RC+/high DR vs RC-/low DR · risk increased stepwise
- higher risk 1.9-fold
- primary outcome occurred in all patients
- 36%
Further pooled results
Primary outcome by OES > 0
| Comparison | HR (95% CI) | |
|---|---|---|
| OES > 0 · limited risk discrimination | 1.19 (0.90–1.59) | |
| 0.512Hazard ratio (log scale) |
| Outcome | higher risk |
|---|---|
| Primary outcome by NT-proBNP ≤30% reduction | 1.7-fold |
Congestion (OES > 0) · admission and 72 hours
- OES > 0 at admission
- 93%
- at 72 hours
- 57%
- DR remained stable
Original publication
Clinical profiles to guide decongestion in acute heart failure. Am Heart J. Published 9 June 2026. doi:10.1016/j.ahj.2026.107510
Summarised from the published abstract; every number is checked against it