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Recommendation Table 8 — Recommendations for pre-discharge and early post-discharge follow-up of patients hospitalized for decompensated heart failure (see Evidence Tables 59–67)
Recommendations Classa Levelb Careful evaluationc before discharge is recommended in patients hospitalized for DHF to exclude persistent signs of congestion. I C An intensive strategy of rapid initiation and uptitration of FMT before discharge and during frequent follow-up visits in the first 6 weeks following an HFH is recommended to reduce the risk of HF rehospitalization or death.311 I B2 © ESC 2026 DHF, decompensated heart failure; FMT, foundational medical therapy; HF, heart failure; HFH, heart failure hospitalization. aClass of recommendation. bLevel of evidence. cClinical evaluation, natriuretic peptide levels (Table 9), kidney function and electrolytes, imaging (see Figure 14).
≤
∆≥
∆
Figure 14 Tools used for assessment of decongestion during the pre-discharge phase. All these tools are intended to be optional as no evidence from randomized controlled trials exists. BNP, B-type natriuretic peptide; CSI, congestion score index; EDT, E-wave deceleration time; IVC, inferior vena cava; LUS, lung ultrasound; LV, left ventricular; NP, natriuretic peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; NYHA, New York Heart Association; TRV, tricuspid regurgitation velocity. aCongestion score = 0 denotes the absence of clinical congestion (absence of dyspnoea, orthopnoea, fatigue, rales, oedemas, jugular vein distension).497 Congestion score = 1–2 denotes mild congestion (slight or moderate dyspnoea, orthopnoea, fatigue, rales, oedemas, jugular vein distension).497 bThe CSI is a six-zone evaluation of a chest X-ray, with individual scores ranging from 0 to 3. A total score of 0 indicates all zones are clear (i.e. no congestion). cThe IVC is an optional tool to assess decongestion, although CAVA-ADHF showed no added benefit498. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026
