Selvaraj S, Claggett B, Pozzi A, et al. - Among participants from PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in HF), researchers examined the link between physical signs of congestion, at baseline and during study follow-up, and quality of life and clinical results. They also evaluated the therapeutic influences of sacubitril/valsartan on congestion. This study included 8,380 participants, in whom, the presence of 0, 1, 2, and 3+ signs of congestion was detected in 70%, 21%, 7%, and 2% of patients, respectively. Findings revealed significant independent prognostic value was offered by physical exam in heart failure with reduced ejection fraction, even beyond symptoms, natriuretic peptides, and Meta-Analysis Global Group in Chronic Heart Failure risk score. A greater extent of improvement in the congestion was achieved with sacubitril/valsartan vs enalapril. An independent link of decreasing congestion in the outpatient setting, with improved quality of life and reduced cardiovascular events, including death, was also revealed.