title: Algorithm-based assessment of target weight removal in acute decompensated heart failure.
abstract: Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization. The majority of these patients are admitted for volume overload, with fluid removal as the main therapeutic target. Practice guidelines do not appoint methods for determining the amount of volume that should be removed. The authors hypothesize that rigorous, protocol-driven establishment of a target weight to be removed would enhance actual volume removal and short-term outcomes. Forty-seven patients admitted with ADHF were enrolled. Each patient had target weight removal (TWR) determined by a heart failure (HF) specialist (serving as the gold standard). Separately, a nurse practitioner calculated the TWR from an algorithm using: (1) baseline weight, (2) renal function, and (3) degree of lower extremity edema. There was good correlation of TWR from an algorithmic approach compared with expert determination (r2 =0.8). A total of 87% of patients reached a discharge weight within 20% of the TWR. A more standardized approach to estimating target weight loss for hospitalized HF patients approximates those of HF specialists. Furthermore, this algorithm could be utilized by general practitioners in settings where an HF specialist is not readily available.
authors.affiliation: Heart and Vascular Center at the Christ Hospital, Cincinnati, OH, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: O'Brien
authors.forename: Santosh
authors.initials: S
authors.lastname: Menon
authors.forename: Tracy
authors.initials: T
authors.lastname: Stephens
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Chung
mesh_terms: D000465:Algorithms; D001826:Body Fluids; D001835:Body Weight; D004232:Diuretics / Q000008:administration & dosage; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D006440:Hemofiltration; D006801:Humans; D007902:Length of Stay; D009820:Ohio; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome
chemical_list: D004232:Diuretics