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

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Michael Kleiner Shochat, MD, BSc, PhD, FACC Daniel Kapustin, BSc Marat Fudim, MD, MHS Mark Kazatsker, MD Ilia Kleiner, MD Jean Marc Weinstein, MBBS, FRCP Gurusher Panjrath, MD, FACC, FAHA Guy Rozen, MD, MHA Ariel Roguin, MD, PhD Simcha R Meisel, MD, MSc, FACC

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.


 

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: 25 june 2022. doi: https://doi.org/10.18103/mra.v10i5.2766.
Section
Case Reports

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