Edema Index-Guided Disease Management Improves 6-Month Outcomes of Patients With Acute Heart Failure

The efficacy of heart failure (HF) management programs is compromised by the challenge of early identification of patients at imminent risk. Segmental multifrequency bioelectrical impedance analysis can generate an "edema index" (El) as a surrogate for the body fluid status. In this study, we tested whether integration of El-guided management improved the 6-month outcomes of HE patients under multidisciplinary care. In total, 159 patients with acute HE were randomized into control, case management (CM), and El-guided CM (El) groups (n = 53 in each group). In the El group, a management algorithm was designed based on the measured El. The analyzed endpoints included HE-related and all cause-related events during the 6-month follow-up period. In the 6 months, there were 11(6.9%) deaths, 19 (11.9%) HF-related rehospitalizations, and 45 (28.3%) all-cause-related rehospitalizations. Compared to the control (26.4%) and CM groups (15.1%), the El group had a lower rate of HF-related death and rehospitalization (3.8%, P = 0.004). Multivariate analysis revealed that El-guided management was an independent predictor of a lower HE-related event rate (hazard ratio = 0.15, 95%CI = 0.03 similar to 0.66, P = 0.012). Patients with a higher pre-discharge El were older, had lower blood albumin and hemoglobin levels, and had a higher functional class and incidences of diabetes mellitus and chronic kidney disease. An increase in the pre-discharge El by 0.001 increased the HF-related event rate by 6% (P = 0.002). Use of El-guided management lowered this risk (P = 0.03). In conclusion, an El-based HE management program demonstrated an event-lowering effect superior to traditional nurse-led multidisciplinary care in 6 months after an acute HE episode. (Int Heart J 2012; 53: 11-17)