Abstract
AIMS: Signs of congestion are a treatment target in patients with heart failure (HF), as they affect patients' well-being, and congestion scores are associated with the risk of early readmission. However, which individual sign of congestion has the strongest association with quality of life (QoL) and HF rehospitalization remains uncertain. METHODS AND RESULTS: We included 1551 HF patients hospitalized for worsening HF. QoL was assessed using the Kansas City Cardiomyopathy Questionnaire-23 (KCCQ-23) on the same day as physical examination. We performed linear and Cox regression to find associations of signs of HF to QoL and 60 day HF rehospitalization. All analyses were externally validated in a similar independent cohort. Patients with worse QoL were older and more often female and had more comorbidities and signs of HF. In multivariable regression analyses, peripheral oedema and orthopnoea (standardized beta -0.210, P < 0.001 and standardized beta -0.206, P < 0.001, respectively) had the strongest association with worse QoL. Elevated jugular venous pressure (JVP) was the only multivariable adjusted congestive sign associated with a higher risk of 60 day HF rehospitalization [hazard ratio (HR) 1.64 (1.03-2.60), P = 0.038]. QoL was significantly associated with 60 day HF rehospitalization [HR 1.09 (1.04-1.14), per 5-unit Kansas City Cardiomyopathy Questionnaire (KCCQ) decrease; P < 0.001]. The presence or absence of signs of congestion did not modify the association between QoL and 60 day HF rehospitalization. CONCLUSIONS: Peripheral oedema and orthopnoea showed the strongest association with QoL in patients admitted for HF. JVP had the strongest association with the risk of 60 day rehospitalization. Clinically, it is important to distinguish between individual signs due to the discrepancy of their impact on outcome.