Clinical Importance of Markers of Congestion over Time in Patients with Heart Failure with Preserved Ejection Fraction

Abstract

Background In patients with heart failure, the physical examination is an important aspect of management. However, the prognostic significance of changes in physical examination markers of congestion (MOC) over time in patients with HFpEF is unclear. Objectives To describe the association of changes in physical examination MOC collected serially over time with outcomes in patients with HFpEF. Methods We analyzed serial physical examination data for 1,644 participants in the Americas cohort of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist Trial. Multivariable adjusted proportional hazards models determined the association of serial physical examination MOC, including JVP ≥10 cm, edema, or rales, as a time-updated covariate with the primary composite endpoint of cardiovascular death, aborted cardiac death, or heart failure hospitalization. The prevalence and standard error of the physical examination MOC per month over 2 years before this event was additionally calculated. Findings At baseline, 304 patients (18%) had jugular venous pressure ≥10 cm, 1265 (78%) had edema, and 292 (17%) had rales. The probability of having JVP ≥10 cm or rales was relatively unchanged during each month preceding the primary composite endpoint. After multivariable adjustment, each physical examination MOC was independently associated with a higher risk of the primary composite endpoint (HR for JVP ≥10 cm 1.95, 95% CI [1.51-2.51], p Conclusions When assessed over a period of time, each of the physical examination MOC was closely associated with risk. Unlike JVP and rales, the probability of the presence of edema increased prior to the primary composite endpoint. These findings underscore the importance of a careful physical examination in HFpEF.