Early Intervention with Impedance-guided Heart Failure Management Improves Long-term Outcome: Insights from the IMPEDANCE-HF Trial

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Published Jun 1, 2022
DOI: https://doi.org/10.18103/mra.v10i5.2766

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Main Article Content

Michael Kleiner Shochat, MD, BSc, PhD, FACC
Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel
Daniel Kapustin, BSc
University of Toronto Faculty of Medicine, Toronto, Canada
Marat Fudim, MD, MHS
Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
Mark Kazatsker, MD
Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel
Ilia Kleiner, MD
Cardiology Department, University Medical Center, Beer Sheva, Israel
Jean Marc Weinstein, MBBS, FRCP
Cardiology Department, University Medical Center, Beer Sheva, Israel
Gurusher Panjrath, MD, FACC, FAHA
Department of Medicine (Cardiology), George Washington University School of Medicine and Health Sciences, Washington DC
Guy Rozen, MD, MHA
Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel
Ariel Roguin, MD, PhD
Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel
Simcha R Meisel, MD, MSc, FACC
Department of Medicine (Cardiology), George Washington University School of Medicine and Health Sciences, Washington DC

Abstract

Background: Lung-impedance (LI) guided treatment of heart failure (HF) patients was shown to improve clinical outcomes.


Objectives: To perform a post-hoc analysis of the IMPEDANCE-HF extended trial in order to explore the mechanism underlying the improved outcome of the LI-guided compared with conventional therapy of HF patients.


Methods: The study included 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 upon enrollment. The level of pulmonary congestion (LPC) was represented by ΔLIR= [(measured LI/NLI)-1] × 100%.


Results: There were 11473 outpatient visits in the LI-guided group and 10245 visits in the control group during follow-up, or 15.5 and 15.9 visits/patient×year, respectively (p=0.74). The LI-guided patients were on average less congested during follow-up than those in the control group (by 20 %, p<0.01). Multivariate regression analysis showed that the likelihood of hospitalization for HF [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.52-0.72, p<0.01) and of all-cause mortality (HR: 0.83, 95%CI: 0.70-0.98, p=0.03] were lower in the LI-guided group than in the control group. In the LI-guided group, diuretic up-titration was 2-fold more frequent and at an earlier timepoint and at a 21% lower LPC (p<0.01). In both groups the diuretic response was more prominent when up-titration was done at a lower LPC (p<0.01).   


Conclusion LI-guided diuretic titration prompted earlier, and more frequent diuretic dose increase when the LPC was only beginning to increase and this resulted in a greater decongestive response with better clinical outcomes.


 

Keywords: heart failure, heart failure readmission, lung impedance, clinical outcome in heart failure patients, diuretic response

Article Details

How to Cite
SHOCHAT, Michael Kleiner et al. Early Intervention with Impedance-guided Heart Failure Management Improves Long-term Outcome: Insights from the IMPEDANCE-HF Trial. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2766>. Date accessed: 05 nov. 2024. doi: https://doi.org/10.18103/mra.v10i5.2766.
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Issue
Vol 10 No 5 (2022): Vol.10 Issue5, May,2022
Section
Case Reports

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