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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

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Stratifying patients at the risk of heart failure hospitalization using existing device diagnostic thresholds

Vinod Sharma¹, Lisa D Rathman², Roy S Small²

¹Medtronic Inc., Minneapolis, MN, USA.

Heart & Lung : the Journal of Critical Care

|December 29, 2014

Insights

Device observations from cardiac devices can effectively identify patients at high risk for heart failure hospitalization (HFH). This allows for timely interventions, potentially reducing costly hospitalizations and improving patient outcomes.

Area of Science:

Cardiology
Biomedical Engineering
Health Informatics

Background:

Heart failure hospitalizations (HFHs) incur significant healthcare costs annually.
Predicting HFH risk for timely intervention remains a challenge.
Implantable cardiac devices collect data that may indicate HF progression.

Purpose of the Study:

To investigate if existing device observations from CRT-D devices can stratify patients by HFH risk.
To determine the predictive value of device-collected parameters for impending HFHs.

Main Methods:

Analysis of data from 775 patients with CRT-D devices over 13 months.
Evaluation of HFH rates based on the number of device observations, with and without intrathoracic impedance.
Assessment of 30-day HFH risk using data between device interrogation sessions.

Main Results:

A higher number of device observations correlated with an increased likelihood of HFH within 30 days.
Patients with ≥3 device observations showed a 42x higher risk of HFH compared to those with none.
Device parameters, even excluding intrathoracic impedance, effectively stratified HFH risk.

Conclusions:

Existing device observations offer a powerful tool for stratifying patients at different risks of heart failure hospitalization.
This stratification can facilitate proactive management and potentially reduce hospital admissions.

Read full analysis

Abstract

Background:

Heart failure hospitalizations (HFHs) cost the US health care system ∼$20 billion annually. Identifying patients at risk of HFH to enable timely intervention and prevent expensive hospitalization remains a challenge. Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization devices with defibrillation capability (CRT-Ds) collect a host of diagnostic parameters that change with HF status and collectively have the potential to signal an increasing risk of HFH. These device-collected diagnostic parameters include activity, day and night heart rate, atrial tachycardia/atrial fibrillation (AT/AF) burden, mean rate during AT/AF, percent CRT pacing, number of shocks, and intrathoracic impedance. There are thresholds for these parameters that when crossed trigger a notification, referred to as device observation, which gets noted on the device report. We investigated if these existing device observations can stratify patients at varying risk of HFH.

Methods:

We analyzed data from 775 patients (age: 69 ± 11 year, 68% male) with CRT-D devices followed for 13 ± 5 months with adjudicated HFHs. HFH rate was computed for increasing number of device observations. Data were analyzed by both excluding and including intrathoracic impedance. HFH risk was assessed at the time of a device interrogation session, and all the data between previous and current follow-up sessions were used to determine the HFH risk for the next 30 days.

Results:

2276 follow-up sessions in 775 patients were evaluated with 42 HFHs in 37 patients. Percentage of evaluations that were followed by an HFH within the next 30 days increased with increasing number of device observations. Patients with 3 or more device observations were at 42× HFH risk compared to patients with no device observation. Even after excluding intrathoracic impedance, the remaining device parameters effectively stratified patients at HFH risk.

Conclusion:

Available device observations could provide an effective method to stratify patients at varying risk of heart failure hospitalization.

Keywords:

Ambulatory monitoring Heart failure Heart failure hospitalization Implantable device diagnostics Intrathoracic impedance

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