Managing patients with AHF remains a clinical challenge and current therapies have uncertain impacts on long-term morbidity and mortality. The use of therapies that prevent or reverse congestion-induced organ injury may represent a strategy to reduce subsequent organ impairment and morbidity that is more successful than the traditional approach of targeting dyspnoea relief. Although much has been learned about the role of congestion in promoting organ injury, future research efforts should focus on defining the specific pathophysiological mechanisms through which congestion leads to organ injury, determine whether decongestive therapies can prevent or reverse organ impairment, and evaluate the impact of an organ-preserving strategy on long-term clinical outcomes.

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