- For patients with acute (A) heart failure (HF), direct blood volume analysis (BVA) may allow for tailored care and improve outcomes.
- Randomized controlled trial needed.
Why this matters
- Although a pillar of AHF management, diuresis can worsen renal function and is linked to higher mortality.
- Clinician assessments of volume overload in patients with AHF are frequently inaccurate.
- 66% had elevated plasma volume; 37% had true hypervolemia.
- BVA-guided vs controls:
- 30-day readmission: 12.2% vs 27.7% (P<.001>
- HF readmissions: 6.1% vs 20.2% (P<.001>
- Cardiac non-HF readmissions: 1.6% vs 3.9% (P=.012);
- All-cause mortality at 30 days: 2.0% vs 11.1%; at 1 year, 4.9% vs 35.5% (both P<.001>
- Length of stay (LOS): 7.3 vs 5.6 days (P<.001 blood-volume excess were factors>
- Same-day discharge: 16.7% vs 1.4% (P<.001>
- Analysis of 245 consecutive admissions for HF (177 patients) cared for using BVA guidance.
- Upon admission, all underwent direct measurement of total blood volume, red blood cell volume, and plasma volume.
- Treatment targeted total blood volume 6%-8% greater than patient-specific normative values.
- Researchers used propensity score analysis to match participants to database controls (n=2450).
- Outcomes: mortality, rehospitalizations, LOS.
- Single-center retrospective study.