Bioimpedance Spectroscopy A Predictor of Compensated Versus Decompensated Heart Failure In The Emergency Room

Abstract

Introduction Approximately 20% of ambulatory HF care occurs in ER, where the need to exclude PE, COPD, infection and ischemia often govern care, leaving assessment of HF risk and management of diuresis inadequate. ER physicians typically overestimate risk of decompensation in low-risk HF and underestimate risk in high-risk HF patients (pts). Four out of five HF ER pts are admitted and use of an assessment tool at triage and through the continuum could add value. Background The AHA has called for further study of HF pts in ER as there are no consistently used tools for congestion. BIS has been shown to accurately assess ECF levels and as an excellent discriminator for HF caused sob. In previous studies, ECF%TBW has shown value as a tool to risk stratify pts in the acute setting. Further, the higher the ECF%TBW the higher the risk of morbidity. Methods Patients with NYHA II or III heart failure (n=66) were enrolled. There were 6 pts readmitted for heart failure (decomp), while 60 were not (comp). Non-HF data (n=69) was obtained (control). ECF%TBW was evaluated for differences across these 3 groups.ResultsMedian ECF%TBW for decomp, comp and control were 52.5, 48.8, and 44.8%, respectively. Statistically significant differences were shown between all 3 groups (p Conclusions ECF%TBW has been shown as a marker of fluid overload in pts presenting with sob. This bedside device gives instantly useful data, when coupled with physical exam and traditional markers shows promise as a value add in HF care.