Abstract
<h3>Introduction</h3> Lung Impedance (LI) guided treatment of heart failure (HF) patients was shown to improve clinical outcome. <h3>Hypothesis</h3> The aim of the present post-hoc analysis of the IMPEDANCE-HF extended trial was to investigate whether earlier LI-guided drug up titration was associated with a greater improvement in pulmonary congestion (PC) and results in better clinical outcomes. <h3>Methods</h3> The present study was comprised of 290 HF patients with LVEF≤ 45% randomized 1:1 to LI-guided or conventional therapy. The normal LI (NLI), representing the dry lung status, was calculated on study entry. The degree of PC was represented by ΔLIR= [(measured LI/NLI)-1] × 100%. <h3>Results</h3> : There were 11473 and 10245 out-hospital visits in LI-guided and control groups during follow up (FU), (15.5 and 15.9 per × patient year), respectively, (p=0.74). Patients of the LI-guided group were in average less congested during FU than that in the control group by 20% (p<0.01). Multivariate regression analysis showed that the likelihood of HF hospitalization (hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.52-0.72, p<0.01) and the HR for all-cause mortality was lower in the LI-guided group (0.83, 95%CI: 0.70-0.98, p=0.03). The diuretic up titration was 2-fold times more frequent and done earlier when the degree of PC was by 21% less in LI-guided group, p<0.01. Diuretic down titration was 3.3 times more frequent in LI-guided group, p<0.01. Decongestive effect of diuretics was more prominent in both groups when up titration was done on lower degree of PC, p<0.01. <h3>Conclusions</h3> LI-guided diuretic titration led to earlier intervention on PC and enabled a greater improvement in PC with better clinical outcomes.
Published Version
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