title: Non-Invasive Lung IMPEDANCE-Guided Preemptive Treatment in Chronic Heart Failure Patients: A Randomized Controlled Trial (IMPEDANCE-HF Trial).
abstract: BACKGROUND
  Previous investigations have suggested that lung impedance (LI)-guided treatment reduces hospitalizations for acute heart failure (AHF). A single-blind 2-center trial was performed to evaluate this hypothesis (ClinicalTrials.gov-NCT01315223).
  
  
  METHODS
  The study population included 256 patients from 2 medical centers with chronic heart failure and left ventricular ejection fraction ≤35% in New York Heart Association class II-IV, who were admitted for AHF within 12 months before recruitment. Patients were randomized to a control group treated by clinical assessment and a monitored group whose therapy was also assisted by LI, and followed for at least 12 months. Noninvasive LI measurements were performed with a new high-sensitivity device. Patients, blinded to their assignment group, were scheduled for monthly visits in the outpatient clinics. The primary efficacy endpoint was AHF hospitalizations; the secondary endpoints were all-cause hospitalizations and mortality.
  
  
  RESULTS
  There were 67 vs 158 AHF hospitalizations during the first year (P < .001) and 211 vs 386 AHF hospitalizations (P < .001) during the entire follow-up among the monitored patients (48 ± 32 months) and control patients (39 ± 26 months, P = .01), respectively. During the follow-up, there were 42 and 59 deaths (hazard ratio 0.52, 95% confidence interval 0.35-0.78, P = .002) with 13 and 31 of them resulting from heart failure (hazard ratio 0.30, 95% confidence interval 0.15-0.58 P < .001) in the monitored and control groups, respectively. The incidence of noncardiovascular death was similar.
  
  
  CONCLUSIONS
  Our results seem to validate the concept that LI-guided preemptive treatment of chronic heart failure patients reduces hospitalizations for AHF as well as the incidence of heart failure, cardiovascular, and all-cause mortality.
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel. Electronic address: shochat1@yahoo.com.
authors.forename: Michael Kleiner
authors.initials: MK
authors.lastname: Shochat
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Shotan
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: David S
authors.initials: DS
authors.lastname: Blondheim
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Kazatsker
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Dahan
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Aya
authors.initials: A
authors.lastname: Asif
authors.affiliation: Cardiovascular Institute, Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Yoseph
authors.initials: Y
authors.lastname: Rozenman
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer Sheva, Israel.
authors.forename: Ilia
authors.initials: I
authors.lastname: Kleiner
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer Sheva, Israel.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Weinstein
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Aaron
authors.initials: A
authors.lastname: Frimerman
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Lubov
authors.initials: L
authors.lastname: Vasilenko
authors.affiliation: Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Simcha R
authors.initials: SR
authors.lastname: Meisel
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016001:Confidence Intervals; D004232:Diuretics / Q000627:therapeutic use*; D017097:Electric Impedance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D053442:High-Density Lipoproteins, Pre-beta / Q000008:administration & dosage*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000188:drug therapy; D012016:Reference Values; D012129:Respiratory Function Tests; D016037:Single-Blind Method; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D053442:High-Density Lipoproteins, Pre-beta
keywords: Acute heart failure; chronic heart failure; lung impedance; monitoring heart failure