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Residual congestion on discharge for Heart Failure assessed by impedance technique predicts 30-day and one-year Heart Failure death. Results of IMPEDANCE-HF extended trial

Session Moderated Poster Session - Acute heart failure

Speaker Michael Kleiner Shochat

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Moderated Posters

Authors : M Kleiner Shochat (Hadera,IL), D Kapustin (Toronto,CA), M Fudim (Durham,US), M Kazatsker (Hadera,IL), Y Levy (Hadera,IL), A Asif (Hadera,IL), I Kleiner (Beer Sheva,IL), JM Weinstein (Beer Sheva,IL), G Panjrath (Washington,US), A Roguin (Hadera,IL), S Meisel (Hadera,IL)

Authors:
M Kleiner Shochat1 , D Kapustin2 , M Fudim3 , M Kazatsker1 , Y Levy1 , A Asif1 , I Kleiner4 , JM Weinstein4 , G Panjrath5 , A Roguin1 , S Meisel1 , 1Hillel Yaffe Medical Center, Heart Institute - Hadera - Israel , 2University of Toronto, Internal disease - Toronto - Canada , 3Duke University Medical Center, Cardiology - Durham - United States of America , 4Saroka Medical Center, Cardiology - Beer Sheva - Israel , 5George Washington University School of Medicine and Health Sciences, Cardiology - Washington - United States of America ,

Citation:

The aim of secondary analyses of  the IMPEDANCE-HF extended trial was to find out if residual congestion on discharge for HF could predict 30-day and one-year Heart Failure death.

The analysis of IMPEDANCE-HF extended trial was based on the data collected during the index hospitalization for HF. 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 and patients were hospitalized for HF within 12 months (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. The decisions regarding discharge and choice of treatment were at the discretion of the hospital staff .

A non-invasive impedance device was used in this study to assess the lung fluid content. Unlike the existing impedance devices, the present device has the ability to differentiate a true signal from the lungs from the noise signal of surrounding chest wall. Such approach enables to measure a small change in 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 brackets. (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 < -48.1% - moderate AE.

Results:

LI-guided patients were followed for 61.9.4±39.6 months and control patients for 46.7±33.3 months (p<0.01) accounting for 269 and 470 HF hospitalizations, respectively (p<0.01). Twenty-five (38%) and 57 (66%) HF-associated deaths were recorded during follow-up (p<0.01) representing a mortality rate of 0.03 and 0.1 per patient×year follow up in the LI-guided and control group, respectively (p<0.01). Probability of HF death within 30-day and one year is presented on figure. Conclusion The degree of pre-discharge pulmonary congestion as assessed by LI is a very robust and reliable predictor for 30-day and one-year HF death.

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