Abstract
BackgroundRecurrent heart failure (HF) events are common in patients discharged after acute decompensated heart failure (ADHF). New patient-centered technologies are needed to aid in detecting HF decompensation. Transthoracic bioimpedance noninvasively measures pulmonary fluid retention.ObjectiveThe objectives of our study were to (1) determine whether transthoracic bioimpedance can be measured daily with a novel, noninvasive, wearable fluid accumulation vest (FAV) and transmitted using a mobile phone and (2) establish whether an automated algorithm analyzing daily thoracic bioimpedance values would predict recurrent HF events.MethodsWe prospectively enrolled patients admitted for ADHF. Participants were trained to use a FAV–mobile phone dyad and asked to transmit bioimpedance measurements for 45 consecutive days. We examined the performance of an algorithm analyzing changes in transthoracic bioimpedance as a predictor of HF events (HF readmission, diuretic uptitration) over a 75-day follow-up.ResultsWe observed 64 HF events (18 HF readmissions and 46 diuretic uptitrations) in the 106 participants (67 years; 63.2%, 67/106, male; 48.1%, 51/106, with prior HF) who completed follow-up. History of HF was the only clinical or laboratory factor related to recurrent HF events (P=.04). Among study participants with sufficient FAV data (n=57), an algorithm analyzing thoracic bioimpedance showed 87% sensitivity (95% CI 82-92), 70% specificity (95% CI 68-72), and 72% accuracy (95% CI 70-74) for identifying recurrent HF events.ConclusionsPatients discharged after ADHF can measure and transmit daily transthoracic bioimpedance using a FAV–mobile phone dyad. Algorithms analyzing thoracic bioimpedance may help identify patients at risk for recurrent HF events after hospital discharge.
Highlights
It is estimated that over 25 million people worldwide suffer from heart failure (HF) [1,2]
Among study participants with sufficient fluid accumulation vest (FAV) data (n=57), an algorithm analyzing thoracic bioimpedance showed 87% sensitivity, 70% specificity, and 72% accuracy for identifying recurrent HF events
Patients discharged after acute decompensated heart failure (ADHF) can measure and transmit daily transthoracic bioimpedance using a FAV–mobile phone dyad
Summary
It is estimated that over 25 million people worldwide suffer from heart failure (HF) [1,2]. Many patients with prior HF experience episodes of acute decompensated heart failure (ADHF) [3] Both in Europe and in the United States, ADHF is responsible for nearly 1 million hospitalizations annually, and hospitalization rates from ADHF are increasing with the aging population [4,5,6]. Contemporary HF management programs rely on active surveillance for signs and symptoms of ADHF as well as medication-related and disease-specific education to optimize treatment To date, these programs have shown only modest success. There is, a need to develop new monitoring technologies to augment existing HF management programs To be useful, these technologies must detect ADHF at an early stage, be acceptable to patients, facilitate communication between clinicians and patients, and relate to near-term HF decompensation and clinically relevant events.
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