Title: Integration of Automatic Intrathoracic Fluid Content Measurement into Clinical Decision Making in Patients with Congestive Heart Failure
Background: Hospitalizations
due to decompensation are a frequent problem in treating patients with congestive
heart failure (CHF). Continuous impedance measurement via implantable devices
may detect pulmonary
fluid accumulation due to worsening CHF. An acoustic alert might allow an
earlier treatment of
impending decompensation. An algorithm that implemented impedance measurement
into clinical decision
making in treating CHF patients was evaluated.
Methods: Forty-two CHF
patients (ejection fraction: 27 ± 6%; New
York Heart
Association 2.9 ± 0.6) with
cardiac resynchronization therapy and automatic impedance measurements were
included. Upon an
alert, a stepped therapy was initiated: category (1) overt decompensation,
hospitalization; category (2)
worsened CHF, increase of diuretics; category (3) no CHF worsening, brain
natriuretic peptide (BNP) measurement,
elevated BNP: increase of diuretics, normal BNP: no specific treatment.
Results: During 18 ± 4
months, 45 alerts were treated according to the algorithm. Eleven category 1
alerts led
to hospitalization; 21 category 2 and 11 category 3 patients (elevated BNP)
were treated conservatively. Two category 3 alerts (normal BNP) received no
treatment.
Conclusions: Automatic
impedance measurement can be integrated into CHF management. BNP measurement restricted
to patients with alert but without clinical signs of worsened CHF may prevent
premature therapy escalation. (PACE 2008; 31:961-967)
