Modern Terminology for FOSPE
The modern term for FOSPE (fluid overload with subacute pulmonary edema) is "acute decompensated heart failure" (ADHF) or more broadly "acute heart failure" (AHF), specifically the subtype characterized by worsening or decompensated chronic heart failure with volume overload and pulmonary congestion.
Understanding the Terminology Evolution
The term FOSPE is outdated and has been replaced by more standardized nomenclature in contemporary cardiology practice. The current classification systems recognize that what was previously called "fluid overload with subacute pulmonary edema" represents a specific clinical presentation within the spectrum of acute heart failure syndromes.
Current Classification Framework
According to the ESC Guidelines 1, acute heart failure is defined as rapid onset or change in signs and symptoms requiring urgent therapy, which may be either new HF or worsening of pre-existing chronic HF. The specific presentation you're asking about falls into the category of:
"Worsening or decompensated chronic HF with peripheral edema/congestion" 1 - This describes:
- Progressive worsening of known chronic HF on treatment
- Evidence of systemic and pulmonary congestion
- Gradual accumulation of fluid over days to weeks rather than acute flash pulmonary edema
Key Distinguishing Features
The modern terminology distinguishes between several presentations:
Acute Decompensated Heart Failure (ADHF) 2, 3 is the preferred term when describing patients with known heart failure who experience acute or subacute worsening. This contrasts with:
- Flash pulmonary edema 4 - dramatic, rapid onset (hours) with severe respiratory distress
- Hypertensive HF 1 - acute presentation with high BP and relatively preserved LV function
- De novo AHF 5 - first presentation without prior HF history
Clinical Recognition
The "wet" phenotype 5 describes patients with volume overload evidenced by:
- Pulmonary edema
- Ascites
- Lower extremity edema
- Fluid accumulation present for days to weeks (subacute timeframe)
This matches the FOSPE description and represents the most common presentation, accounting for the majority of AHF hospitalizations.
Practical Application
When documenting or discussing cases previously termed FOSPE, use:
- Primary term: "Acute decompensated heart failure with volume overload"
- Alternative: "Worsening chronic heart failure with pulmonary and systemic congestion"
- Phenotypic descriptor: "Wet HF phenotype"
The shift away from FOSPE reflects modern understanding that this represents a hemodynamic derangement (increased preload from volume overload) 1 rather than a distinct disease entity, and it requires systematic assessment of congestion status and cardiac output to guide therapy 2, 6.