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Device-detected congestion is associated with worse patient-reported outcomes in heart failure

  • Author Footnotes
    1 Present address: University of Washington School of Nursing, Health Sciences Building, Box 357266, 1959 NE Pacific Street, T613, Seattle, WA 98195–7266, USA.
    Jonathan P. Auld
    Correspondence
    Corresponding author.
    Footnotes
    1 Present address: University of Washington School of Nursing, Health Sciences Building, Box 357266, 1959 NE Pacific Street, T613, Seattle, WA 98195–7266, USA.
    Affiliations
    Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA
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  • James O. Mudd
    Affiliations
    Oregon Health & Science University, Knight Cardiovascular Institute, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA
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  • Author Footnotes
    2 Present address: Providence St. Joseph Health, 1111 Northeast 99th Avenue Suite 102, Portland, OR 97220, USA.
    Jill M. Gelow
    Footnotes
    2 Present address: Providence St. Joseph Health, 1111 Northeast 99th Avenue Suite 102, Portland, OR 97220, USA.
    Affiliations
    Oregon Health & Science University, Knight Cardiovascular Institute, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA
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  • Author Footnotes
    3 Present address:William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
    Karen S. Lyons
    Footnotes
    3 Present address:William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
    Affiliations
    Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA
    Search for articles by this author
  • Shirin O. Hiatt
    Affiliations
    Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA
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  • Christopher S. Lee
    Affiliations
    William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
    Search for articles by this author
  • Author Footnotes
    1 Present address: University of Washington School of Nursing, Health Sciences Building, Box 357266, 1959 NE Pacific Street, T613, Seattle, WA 98195–7266, USA.
    2 Present address: Providence St. Joseph Health, 1111 Northeast 99th Avenue Suite 102, Portland, OR 97220, USA.
    3 Present address:William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
Published:January 02, 2019DOI:https://doi.org/10.1016/j.hrtlng.2018.12.003

      Abstract

      Background

      Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms.

      Objective

      To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months.

      Methods

      Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale).

      Results

      The mean age of the sample (n = 49) was 62years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90days reported on average, 130% higher dyspnea (p = 0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p = 0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p = 0.003; CI 19.1%, 257%) and 40% higher anxiety (p = 0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90days were also significantly associated with a clinically meaningful decrease in HRQOL (β = −16.16 ± 6.32; p = 0.01).

      Conclusions

      Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3months.

      Keywords

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