Conclusions
Congestion is a cardinal clinical feature of chronic HF, and is linked to adverse outcomes. Although several interventions might improve congestion, it often remains underdiagnosed. Little is known about the effects of the anti-congestive drugs par excellence, the diuretics, on hard outcome measures, such as mortality. More objective measures of congestion (such as raised NPs, or dilated vena cava on ultrasound) might allow the identification of higher risk patients: trials are then needed to test therapeutic decongestive strategies in order to establish whether increased loop diuretic doses, combined diuretics or more aggressive interventions, such as peritoneal dialysis, might improve the patient’s clinical status and, possibly, outcome.