Device-detected congestion is associated with worse patient-reported outcomes in heart failure.
Jonathan P Auld, James O Mudd, Jill M Gelow and 3 others
PMID 30611529WHAT IT FOUND
Device-detected fluid congestion in patients with heart failure was linked to worse quality of life and several symptoms after accounting for other factors.
Direct comparisons showed no clear differences, and the longest congestion periods did not show the same broad worsening.
Key findings
01Unadjusted comparisons found no statistically significant differences in symptoms between patients with and without threshold crossings, or among patients grouped by 0, 4–22, or 23–56 days above threshold.
02In adjusted models, having at least one threshold crossing and having 4–22 days above threshold were associated with worse heart failure-specific quality of life.
03In adjusted symptom models, dyspnea, early and subtle symptoms, depressive symptoms, and anxiety symptoms were worse for patients with threshold crossings or with 4–22 days above threshold; only depressive symptoms were also worse for patients with 23 days or more above threshold.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 49 patients, which limited the number of covariates and the ability to detect smaller effects. The sample had little variation in self-reported race and in use of certain medications such as beta-blockers and ACE/ARBs. Device congestion data began only after 34 days post-implantation, and major surgery within 6 weeks was an exclusion criterion, so the findings may not apply to the very early post-implant period. Unadjusted symptom comparisons were not significant, while adjusted associations were, so the strength of the association depends on the modeling approach.
Declared interests
The study was sponsored by the National Institutes of Health. The supplied text gives no additional funding or author conflict-of-interest declarations.
The easy way to misread this
Do not conclude that device-detected congestion alone predicts how a patient feels. When the groups were compared directly, symptom differences were not clear, and the longest-duration congestion group did not show the same broad worsening as the shorter-duration congestion group.