Acute HF: blood volume analysis-guided therapy linked to lower mortality

  • Strobeck JE & al.
  • JACC Heart Fail
  • 4 Oct 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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>
  • Patients with preserved or reduced ejection fraction did better than controls.

Study design

  • 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.

Limitations

  • Single-center retrospective study.

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