Change in intrathoracic impedance measures during acute decompensated heart failure admission: results from the Diagnostic Data for Discharge in Heart Failure Patients (3D-HF) Pilot Study.
BACKGROUND
Despite the high number of admissions for acute decompensated heart failure (ADHF), there are no specific criteria for discharge readiness. A number of patients have implantable devices that might provide data to assist in determining readiness for discharge.


RESULTS
The 3D-HF (Diagnostic Data for Discharge in Heart Failure Patients) study was a prospective observational pilot study enrolling HF patients with Optivol-capable cardiac devices within 48 hours of a hospital admission characterized by worsening HF symptoms. The primary end point was the difference in times from admission to 50% improvement in impedance and to when patient was medically ready for discharge. The nonparametric sign test was used to determine if the difference was significant. A total of 20 subjects were enrolled over a 24-month period. The median ADHF length of stay was 7 days. Of the 20 subjects, 18 achieved the intrathoracic impedance improvement threshold before discharge. The time to reach the threshold for improvement was 2.5 days (interquartile range 2.0-6.0). The difference between days to 50% impedance and days to provider's discharge decision was 3.0 (P = .0072).


CONCLUSIONS
Intrathoracic impedance changes were evident over a short duration in the majority of patients admitted for ADHF and may be a potential criterion for discharge readiness.
Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. david.whellan@jefferson.edu
David J
DJ
Whellan
Christopher J
CJ
Droogan
James
J
Fitzpatrick
Suzanne
S
Adams
Melissa M
MM
McCarey
Jocelyn
J
Andrel
Paul
P
Mather
Sharon
S
Rubin
Raphael
R
Bonita
Scott
S
Keith
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D058406:Cardiac Resynchronization Therapy; D002307:Cardiography, Impedance; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010414:Pennsylvania; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss