title: Edema index-guided disease management improves 6-month outcomes of patients with acute heart failure.
abstract: The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (EI) as a surrogate for the body fluid status. In this study, we tested whether integration of EI-guided management improved the 6-month outcomes of HF patients under multidisciplinary care. In total, 159 patients with acute HF were randomized into control, case management (CM), and EI-guided CM (EI) groups (n = 53 in each group). In the EI group, a management algorithm was designed based on the measured EI. The analyzed endpoints included HF-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11 (6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the EI group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004).  Multivariate analysis revealed that EI-guided management was an independent predictor of a lower HF-related event rate (hazard ratio = 0.15, 95%CI = 0.03~0.66, P = 0.012). Patients with a higher pre-discharge EI were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge EI by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of EI-guided management lowered this risk (P = 0.03). In conclusion, an EI-based HF management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HF episode.
authors.affiliation: Heart Failure Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine.
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Liu
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Wang
authors.forename: Yu-Yen
authors.initials: YY
authors.lastname: Huang
authors.forename: Tao-Hsin
authors.initials: TH
authors.lastname: Tung
authors.forename: Chii-Ming
authors.initials: CM
authors.lastname: Lee
authors.forename: Ning-I
authors.initials: NI
authors.lastname: Yang
authors.forename: Jong-Shyan
authors.initials: JS
authors.lastname: Wang
authors.forename: Li-Tang
authors.initials: LT
authors.lastname: Kuo
authors.forename: Wen-Jin
authors.initials: WJ
authors.lastname: Cherng
mesh_terms: D000368:Aged; D000465:Algorithms; D004487:Edema / Q000175:diagnosis; D017097:Electric Impedance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index