Lung Impedance Guided Therapy Reduces Hospitalizations in Heart Failure with Preserved Ejection Fraction: A...

Area of Science:

• Cardiology
• Medical Devices
• Clinical Trials

Background:

• Prior studies indicated lung impedance (LI)-guided therapy reduces heart failure (HF) hospitalizations in patients with HF with reduced ejection fraction (HFrEF).
• Heart failure with preserved ejection fraction (HFpEF) remains a significant clinical challenge with limited therapeutic options.

Purpose of the Study:

• To evaluate the efficacy of LI-guided management in reducing HF hospitalizations and mortality in patients with HFpEF.
• To assess the role of the Lung Impedance Ratio (LIR) as a real-time fluid index for guiding decongestion therapy.

Main Methods:

• A proof-of-concept, single-blind, randomized controlled trial involving 150 HFpEF patients.
• Patients were randomized 1:1 to LI-guided management or usual care, with LI measured noninvasively using the CardioSet device.
• The primary endpoint was recurrent HF hospitalization, with a mean follow-up of 38.4 months.

Main Results:

• HF hospitalizations were significantly reduced in the LI-guided group (HR 0.26; p<0.001).
• All-cause mortality (HR 0.40; p=0.02) and HF-specific mortality (HR 0.26; p=0.02) were also significantly lower.
• LI-guided patients spent more time within the therapeutic LIR range (97% vs 49%; p<0.001) through precision timing of decongestion.

Conclusions:

• LI-guided management significantly reduced HF hospitalizations, all-cause mortality, and HF-specific mortality in HFpEF.
• The study demonstrated the benefit of precision timing of decongestion using LI-guided therapy.
• LI-guided management offers a promising strategy for improving outcomes in HFpEF patients.