Abnormal hydration status of patients with acute heart failure predicts the risk of rehospitalization and death in the following year
“Bioelectrical impedance vector analysis and clinical outcomes in patients with acute heart failure”
J Nunez, B Mascarell, H Stubbe, S Ventura, C Bonanad, V Bodí, E Nunez, G Minana, L Facila, AO Bayés-Genis, FJ Chorro and J Sanchis
J Cardiovasc Med (Hagerstown). 2016 Apr; 17(4):283-90. doi: 10.2459/JCM.0000000000000208
Acute heart failure (AHF) is associated with congestion (fluid overload), which may present as pulmonary edema, leg swelling, and ascites. Because congestion is a negative prognostic marker, the accurate assessment of these patients’ hydration status is important for guiding treatment decisions. Researchers in Spain used bioimpedance vector analysis (BIVA) to assess hydration status in AHF patients and evaluated its ability to predict rehospitalization and mortality.
A total of 369 patients with new AHF or decompensated chronic heart failure underwent BIVA in supine position before discharge from hospital. A CardioEFG device (Akern), operating at 50 kHz, was used, and patients were classified into three categories, namely dehydration (<72.7%), normohydration (72.7–74.3%) and hyperhydration (>74.3%).
At discharge, 62 patients were found to be dehydrated, 166 had normal hydration, and 141 had hyperhydration. At a median follow-up of one year, 80 patients had died and 93 required readmission for heart failure. Mortality rates were lowest among normohydrated patients (15.1%), intermediate among dehydrated patients (19.4%) and highest in the hyperhydrated group (30.5%). The readmission rate was also highest among hyperhydrated cases (29.1% vs. 19.4% and 24.1% in dehydrated and normohydrated cases, respectively). In multivariable analyses, BIVA hydration status was significantly associated with mortality and readmission rates.
The authors concluded that their study “may encourage the use of this technique not only for monitoring hydration status during AHF hospitalization (and, perhaps, tailoring diuretic therapy) but also for discharge risk stratification.” They also noted that, because BIVA can detect dehydration, it may be used to identify “patients in which fluid overload was not the main pathophysiological mechanism causing decompensations [and who may have received] excessive/inappropriate decongestive treatments.”
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