Changes in Intrathoracic Impedance are Associated With Subsequent Risk of Hospitalizations for Acute Decompensated Heart Failure: Clinical Utility of Implanted Device Monitoring Without a Patient Alert

Small, Roy S.; Wickemeyer, William; Hoppe, Bobbi; Andrulli, John; Brady, Peter A.; Labeau, Melody; Koehler, Jodi; Sarkar, Shantanu; Hettrick, Douglas A.; Tang, W.H. Wilson

doi:10.1016/j.cardfail.2009.01.012

Cited by 101 publications

(79 citation statements)

References 13 publications

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“…However, a strategy that triggers healthcare use on the basis of patient alerts for possible fluid overload may not be the appropriate way to incorporate diagnostic device features into routine patient management, as shown here. In contrast to earlier studies, 20,24 remote patient monitoring via CareLink was not available in the present study, so any review of diagnostic information inevitably required an outpatient visit.…”

Section: Van Veldhuisen Et Al Results Of the Diagnostic Outcome Trialmentioning

confidence: 86%

Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure

et al. 2011

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Background-Heart failure is associated with frequent hospitalizations, often resulting from volume overload. Measurement of intrathoracic impedance with an implanted device with an audible patient alert may detect increases in pulmonary fluid retention early. We hypothesized that early intervention could prevent hospitalizations and affect outcome. Methods and Results-We studied 335 patients with chronic heart failure who had undergone implantation of an implantable cardioverter-defibrillator alone (18%) or with cardiac resynchronization therapy (82%). All devices featured a monitoring tool to track changes in intrathoracic impedance (OptiVol) and other diagnostic parameters. Patients were randomized to have information available to physicians and patients as an audible alert in case of preset threshold crossings (access arm) or not (control arm). The primary end point was a composite of all-cause mortality and heart failure hospitalizations. During 14.9Ϯ5.4 months, this occurred in 48 patients (29%) in the access arm and in 33 patients (20%) in the control arm (Pϭ0.063; hazard ratio, 1.52; 95% confidence interval, 0.97-2.37). This was due mainly to more heart failure hospitalizations (hazard ratio, 1.79; 95% confidence interval, 1.08 -2.95; Pϭ0.022), whereas the number of deaths was comparable (19 versus 15; Pϭ0.54). The number of outpatient visits was higher in the access arm (250 versus 84; PϽ0.0001), with relatively more signs of heart failure among control patients during outpatient visits. Although the trial was terminated as a result of slow enrollment, a post hoc futility analysis indicated that a positive result would have been unlikely. Conclusion-Use of an implantable diagnostic tool to measure intrathoracic impedance with an audible patient alert did not improve outcome and increased heart failure hospitalizations and outpatient visits in heart failure patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00480077.

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Section: Van Veldhuisen Et Al Results Of the Diagnostic Outcome Trialmentioning

confidence: 86%

Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure

et al. 2011

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“…The identification of the frequent or extended crossing of the intrathoracic impedance threshold during follow-up may reflect a high risk for the development of adverse clinical events, such as hospitalization. 10) The relative sensitivity and rate of detecting unexplained changes in intrathoracic impedance were much higher (76% versus 23%) and lower (1.9 versus 4.3), respectively, in comparison to standard heart failure monitoring using daily weight changes. Intrathoracic impedance monitoring represents a useful adjunctive clinical tool for managing heart failure patients with implanted devices.…”

Section: Discussionmentioning

confidence: 88%

Utility of Fluid Assessment Based on the Intrathoracic Impedance Monitoring in a Peripartum Woman with Heart Disease

et al. 2018

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SummaryRecently, implantable cardioverter-defibrillators (ICD) have become capable of monitoring intrathoracic impedance to detect an increased fluid volume and heart failure. Pregnancy is a well-known cause of an increased body fluid volume; however, it is not clear whether the measurement of intrathoracic impedance by ICD is clinically useful for precisely detecting heart failure in pregnant women. We herein report the case of a 39-yearold woman with an ICD that had been implanted after an event of ventricular fibrillation due to severe aortic regurgitation with a bicuspid aortic valve. Elevated right ventricular pressure and brain natriuretic peptide levels were detected at 37 weeks of gestation and postpartum. At the same time, the ICD's stored fluid index gradually increased and exceeded the threshold on the 10th day after delivery. She was treated with diuretics and recovered from postpartum heart failure. The physiological volume changed in the perinatal period, but we were still able to detect heart failure by ICD. Intrathoracic impedance monitoring is effective in the perinatal field.(Int Heart J Advance Publication)

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“…[50][51][52][53] Direct pulmonary artery pressure device monitors have had promising results in the management of heart failure. The CardioMEMS TM device by St Jude Medical (Atlanta, GA, USA) is placed in the pulmonary artery during a right heart catheterisation and allows for measurement of pulmonary artery pressures.…”

Section: Strategies To Guide Diuretic Titrationmentioning

confidence: 99%

Dilemmas in the Dosing of Heart Failure Drugs: Titrating Diuretics in Chronic Heart Failure

Pham

Grodin

2017

Cardiac Failure Review

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Despite advances in medical therapy over the past few decades, the incidence of heart failure hospitalisation continues to rise. Diuretics are the most common therapy used to treat heart failure as they relieve congestion. However, there is a lack of guidance on how to best use these medications. Guidelines support the use of diuretics at the lowest clinically effective dose but do not specify a diuretic strategy beyond that. Here we review the diuretics available for treatment, potential mechanisms of diuretic resistance and ways to address this in the ambulatory setting, and review tools that have been developed to help guide diuretic use in the treatment of chronic heart failure.

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Changes in Intrathoracic Impedance are Associated With Subsequent Risk of Hospitalizations for Acute Decompensated Heart Failure: Clinical Utility of Implanted Device Monitoring Without a Patient Alert

Cited by 101 publications

References 13 publications

Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure

Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure

Utility of Fluid Assessment Based on the Intrathoracic Impedance Monitoring in a Peripartum Woman with Heart Disease

Dilemmas in the Dosing of Heart Failure Drugs: Titrating Diuretics in Chronic Heart Failure

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