Abstract
BackgroundIncomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. However, congestion can be difficult to evaluate, stressing the urgent need for new objective approaches. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments.ObjectiveThis study aimed to determine whether in-hospital bioimpedance monitoring can be used to track fluid changes (ie, the efficacy of decongestion therapy) and the relationships between bioimpedance changes and HF hospitalization and all-cause mortality.MethodsA wearable bioimpedance monitoring device was used for thoracic impedance measurements. Thirty-six patients with signs of acute decompensated HF and volume overload were included. Changes in the resistance at 80 kHz (R80kHz) were analyzed, with fluid balance (fluid in/out) used as a reference. Patients were divided into two groups depending on the change in R80kHz during hospitalization: increase in R80kHz or decrease in R80kHz. Clinical outcomes in terms of HF rehospitalization and all-cause mortality were studied at 30 days and 1 year of follow-up.ResultsDuring hospitalization, R80kHz increased for 24 patients, and decreased for 12 patients. For the total study sample, a moderate negative correlation was found between changes in fluid balance (in/out) and relative changes in R80kHz during hospitalization (rs=-0.51, P<.001). Clinical outcomes at both 30 days and 1 year of follow-up were significantly better for patients with an increase in R80kHz. At 1 year of follow-up, 88% (21/24) of patients with an increase in R80kHz were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R80kHz (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and HF hospitalization, respectively (P=.01). A decrease in R80kHz resulted in a significant hazard ratio of 4.96 (95% CI 1.82-14.37, P=.003) on the composite endpoint.ConclusionsThe wearable bioimpedance device was able to track changes in fluid status during hospitalization and is a convenient method to assess the efficacy of decongestion therapy during hospitalization. Patients who do not show an improvement in thoracic impedance tend to have worse clinical outcomes, indicating the potential use of thoracic impedance as a prognostic parameter.
Highlights
Heart failure (HF) is a major and increasing public health problem worldwide and is characterized by frequenthospitalizations that are mainly caused by congestion [1,2]
For the total study sample, a moderate negative correlation was found between changes in fluid balance and relative changes in resistance at 80 kHz (R80kHz) during hospitalization
At 1 year of follow-up, 88% (21/24) of patients with an increase in R80kHz were free from all-cause mortality, compared with 50% (6/12) of patients with a decrease in R80kHz (P=.01); 75% (18/24) and 25% (3/12) were free from all-cause mortality and heart failure (HF) hospitalization, respectively (P=.01)
Summary
Heart failure (HF) is a major and increasing public health problem worldwide and is characterized by frequent (re)hospitalizations that are mainly caused by congestion [1,2]. Congestion is related to water and sodium retention and is defined as a high left ventricular end-diastolic pressure (ie, pressure overload) followed by signs and symptoms such as dyspnea, rales, and edema (ie, volume overload) [3,4]. Assessing a patient’s congestion status and treatment efficacy remains difficult and is mainly done by physical examination (ie, dyspnea, orthopnea, edema) or radiographic signs on chest X-ray (ie, interstitial edema, pleural effusion). Physical examination results and radiographic signs have poor sensitivity and predictive value [5,6]. Guidelines or specific criteria to define treatment efficacy and discharge readiness of patients presenting with acute decompensated HF are vague or missing. Incomplete relief of congestion in acute decompensated heart failure (HF) is related to poor outcomes. Due to its inverse correlation with tissue hydration, continuous bioimpedance monitoring might be an effective method for serial fluid status assessments
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