Use of Fluid Accumulation Monitoring in HF Patients
Decompensated heart failure (HF) is the leading cause of hospital admissions for US Medicare patients. Early detection of intrathoracic fluid accumulation may reduce the morbidity and mortality associated with cardiac decompensation. Much of the medical costs incurred by decompensated HF patients are related to hospitalization and rehospitalization . Therefore, monitoring pulmonary fluid status may be valuable in detecting early decompensation, and the following adjustment of medical therapy may prevent hospitalization. The new generation of cardiac resynchronization therapy devices, biventricular implantable cardioverter-defibrillators (ICDs; Medtronic, Minneapolis, MN, USA), permit intrathoracic impedance measurements and thus the detection of changes in pulmonary fluid status. The feasibility of the InSync Sentry device was recently reported by Yu et al. , who demonstrated an inverse correlation of intrathoracic impedance and pulmonary capillary wedge pressure with fluid balance. Furthermore, in these devices, an audible alarm (the OptiVol alert) can be triggered when a decrease in intrathoracic impedance indicates pulmonary fluid accumulation secondary to left-sided HF. Accordingly, these new devices may detect HF in the preclinical phase, which may allow the adjustment of therapy and thereby obviate the need for HF-related hospitalization. Therefore, the aim of this study was to evaluate the clinical value of this alarm for patients with decompensated HF.
KeywordsCardiac Resynchronization Therapy Pulmonary Capillary Wedge Pressure Decompensated Heart Failure Left Ventricular Lead Measure Left Ventricular Ejection Fraction
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