ESCAPE Hemodynamic Congestion Index (HCI) Calculator
ESCAPE Trial Hemodynamic Congestion Index: Rationale, clinical meaning, and evidence
The Hemodynamic Congestion Index (HCI) implemented here is the simple sum of right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP): HCI = RAP (mmHg) + PCWP (mmHg). This index was derived from analyses of the ESCAPE trial dataset and related secondary analyses that examined whether a single composite invasive pressure target could summarise residual intravascular congestion and predict 6-month outcomes. In analyses using ESCAPE pulmonary-artery catheter data, a post-treatment RAP+PCWP threshold of 30 mmHg distinguished two groups with markedly different outcomes: patients with post-treatment RAP+PCWP < 30 mmHg experienced substantially lower 6-month mortality and readmission compared with those with RAP+PCWP ≥ 30 mmHg. Thus, HCI provides a pragmatic, evidence-based single-number summary of invasive right- and left-sided filling pressures and can help identify patients who remain hemodynamically congested despite therapy and who may benefit from closer follow-up or intensified decongestive strategies.
Reference:
Binanay C, et al. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) — main trial description and hemodynamic targets (JAMA 2005).
Ma TS, Paniagua D, et al. Usefulness of the Sum of Pulmonary Capillary Wedge Pressure and Right Atrial Pressure as a Congestion Index that Prognosticates Heart Failure Survival (ESCAPE data analyses; American Journal of Cardiology 2016 abstract/analysis). This analysis proposed the RAP+PCWP threshold (30 mmHg) and reported the contrasting 6-month outcomes for the two groups.
For synthesis and modeling of decongestion metrics using ESCAPE data (including multivariable models and performance metrics), see the review “Decongestion Models and Metrics in Acute Heart Failure: ESCAPE Data in the Age of the Implantable Cardiac Pressure Monitor” (Paniagua et al., 2022).