Problem of 30-Day Readmission for Heart Failure Could Be Improved. Results of IMPEDANCE-HF Extended Trial

Abstract

The aim of secondary analyses of the IMPEDANCE-HF extended trial was to find out if degree of residual congestion on discharge for HF could predict 30-day readmission. The IMPEDANCE-HF extended trial was a randomized controlled single-blinded trial of HF with reduced LVEF patients. Inclusion criteria were LVEF ≤ 45%, NYHA class II-IV (ClinicalTrials.gov NCT01315223). Half of the patients (N=145) were assigned to the active Lung Impedance (LI)-guided treatment arm where clinicians were based therapy on LI level. The other half was assigned to the control arm where LI values were recorded but not conveyed to the clinical treatment team. In the case of hospitalization, LI was recorded in all patients at discharge. A non-invasive impedance device (“CardioSet” Company, Tel Aviv) was used in this study to assess the lung fluid content. A method to determine individual “dry” baseline LI (BLI) for each HF patient has been reported. BLI for each patient was used to calculate a new parameter, the ∆LIR= [(current LI/BLI)-1] × 100%, which determinate the degree of pulmonary congestion in time of measurement. Method. Degree of pulmonary congestion at discharge for HF hospitalization was divided into 5 categories. (1) ∆LIR= 0 to - 18% - minimal interstitial edema (IE), (2) ∆LIR= - 18.1 to -28% - mild IE, (3) ∆LIR= -28.1 to - 38 - moderate IE, (4) ∆LIR= -38.1 to -48% - severe IE to mild alveolar edema (AE) and (5) ∆LIR Results: LI-guided patients were followed for 61.9.4±39.6 months and control patients for 46.7±33.3 months (p Conclusions: The degree of pre-discharge pulmonary congestion as assessedby LI is a very robust and reliable predictor for 30-day readmission. Discharge with degree of pulmonary congestion corresponding to categories 4 and 5 is unacceptable.