Retrospective Evaluation of Remote Dielectric Sensing (ReDS) Vest Technology and its Impact on Heart Failure Readmission Rates and Diuretics Therapy

Abstract

Purpose Early detection of fluid overload in CHF patients has previously shown to improve the quality and efficiency of care. ReDS vest is a non-invasive portable device that detects right lung fluid content. The purpose of this study was to assess if the use of ReDS technology was associated with decreased readmission rates, length of stay (LOS), and improvement in appropriateness of diuretic therapy in patients with CHF at our medical center. Methods An IRB approved retrospective chart review of 112 hospitalized adult patients with acute HF was conducted to evaluate the use of ReDS technology on patient outcomes. The ReDS vest readings were used at admission to aid the diagnosis of acute heart failure and adjust diuretics therapy. A two month time frame was used to assess the outcomes before and after device implementation. Eligible patients admitted June 1st to July 31st in 2017 without the guidance of ReDS vest served as the control group and patients admitted June 1st to July 31st in 2018 with the guidance of ReDS vest served as the study group. Baseline characteristics such as ejection fraction, BMP results, age, gender, and home and discharge diuretic regimens were reviewed. Each ReDS group patient was matched to a control patient based on all three criteria: age (±10 years), LVEF (≤ or >40%), and serum creatinine at admission (±0.3 mg/dL). The primary endpoint of this study was the rate of 30-day readmission. Secondary endpoints included LOS, changes in diuretic therapy based on ReDS reading, and changes in diuretics therapy between prior to admission and at discharge. The McNemar statistical test and the Wilcoxon signed rank test were used to analyze the endpoints. Results A total 56 patients in the ReDS group were matched to 56 patients in the control group. For the primary endpoint of 30 day heart failure readmission rates, there were 4 readmissions in the ReDS group and 10 readmissions in the control group [OR = 2.5 (95% CI: 0.78-7.97); P = 0.09]. For the secondary endpoint of LOS, ReDS group patients stayed an average of 5.2 days and control group patients stayed an average of 6.3 days (p = 0.02). Three patients out of the ReDS group had inpatient diuretics therapy changed due to their ReDS reading. Lastly, when the prior to admissions diuretics therapy was compared to discharge therapy, the ReDS group had 19 patients with new diuretic additions, 8 patients with dose increases of current diuretics, and one patient with both a new addition and increased dose. In the control group, 22 patients had new diuretic additions, 5 patients had dose increases of current diuretics, and one patient had both a new addition and increased dose. Conclusion The use of the technology decreased the LOS for patients admitted for ADHF and was able to augment the clinician's ability to guide therapy for some patients. However, future studies covering a longer time frame are warranted to further evaluate its role in preventing 30 day heart failure readmissions.