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. 2025 Aug;12(4):2477-2486.
doi: 10.1002/ehf2.15277. Epub 2025 Apr 16.

Signs of congestion, quality of life and short-term rehospitalization in patients with heart failure

Geert H D Voordes  1 , Adriaan A Voors  1 , Hailun Qin  1 , Jozine M Ter Maaten  1 , Kevin Damman  1
Affiliations

Signs of congestion, quality of life and short-term rehospitalization in patients with heart failure

Geert H D Voordes et al. ESC Heart Fail. 2025 Aug.

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.

Keywords: biomarkers; congestion; heart failure; quality of life; rehospitalization; signs and symptoms.

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Conflict of interest statement

GHDV and HQ have nothing to disclose. The employer of AAV received consultancy fees and/or research support from Adrenomed, AnaCardio, AstraZeneca, Bayer AG, BMS, Boehringer Ingelheim, Corteria, Eli Lilly, Merck, Moderna, Novartis, Novo Nordisk, Roche Diagnostics and Salubris Bio. KD reports speaker and consultancy fees from Boehringer Ingelheim, AstraZeneca, Abbott, FIRE1 and Echosense. JMtM reports speaker and/or consultancy fees from Novartis, Bayer, Boehringer Ingelheim, Johnson & Johnson, Moderna, Roche and Novo Nordisk and receives grants from the Dutch Heart Foundation and Netherlands Organisation for Scientific Research (NWO) outside the submitted work.

Figures

Figure 1
Figure 1
Forest plot illustrating the interaction between quality of life, signs and symptoms of congestion, and short‐term rehospitalization in the index cohort. Effects are calculated for every 5 points of the Kansas City Cardiomyopathy Questionnaire Overall Summary Score. CI, confidence interval; HR, hazard ratio; JVP, jugular venous pressure; logBio‐ADM, natural logarithm of the biologically active adrenomedullin; logCA125, natural logarithm of the cancer antigen 125; logNTproBNP, natural logarithm of the N‐terminal pro‐brain natriuretic peptide; logUACR, natural logarithm of the urine albumin‐to‐creatinine ratio; NYHA, New York Heart Association.
Figure 2
Figure 2
Concept figure illustrating the effect of the signs of HF on rehospitalization and quality of life (QoL) and the effect of QoL on rehospitalization. Elevated jugular venous pressure (JVP) is associated with a higher risk of rehospitalization in 60 days. Present oedema and orthopnoea are associated with lower QoL. Lower QoL is associated with an increased risk of rehospitalization in 60 days. Created in https://BioRender.com.
See this image and copyright information in PMC

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