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Algorithm-based assessment of target weight removal in acute decompensated heart failure
Thomas M O'Brien1, Santosh Menon, Tracy Stephens
1Heart and Vascular Center at the Christ Hospital, Cincinnati, OH, USA.
Congestive Heart Failure (Greenwich, Conn.)
|January 27, 2012
Summary
A new algorithm for target weight removal in acute decompensated heart failure (ADHF) hospitalization closely matches specialist assessments. This standardized approach aids fluid removal and improves outcomes for heart failure patients.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Acute decompensated heart failure (ADHF) is a primary cause of hospital admission.
- Volume overload is the main reason for ADHF admissions, necessitating fluid removal.
- Current guidelines lack specific methods for determining target fluid removal volumes.
Purpose of the Study:
- To test the hypothesis that a protocol-driven target weight removal (TWR) improves fluid removal and short-term outcomes in ADHF.
- To develop and validate an algorithm for calculating TWR.
Main Methods:
- Forty-seven patients admitted with ADHF were enrolled.
- Target weight removal (TWR) was determined by a heart failure (HF) specialist (gold standard).
- A nurse practitioner calculated TWR using an algorithm based on baseline weight, renal function, and edema.
Main Results:
- The algorithm's TWR showed good correlation with expert determination (r2 = 0.8).
- 87% of patients achieved a discharge weight within 20% of the TWR.
- The algorithm provides a standardized approach comparable to HF specialist estimates.
Conclusions:
- A standardized, algorithmic approach to TWR in hospitalized HF patients effectively approximates specialist assessments.
- This algorithm can be used by general practitioners, especially where HF specialists are unavailable.
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