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

Jonathan P. Auld, James Mudd, Jill Gelow, Karen Lyons, Shirin O. Hiatt, Christopher Lee

    Research output: Contribution to journalArticle

    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 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days 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 90 days 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 3 months.

    Original languageEnglish (US)
    JournalHeart and Lung
    DOIs
    StateAccepted/In press - Jan 1 2019

    Fingerprint

    Heart Failure
    Equipment and Supplies
    Quality of Life
    Confidence Intervals
    Electric Impedance
    Dyspnea
    Anxiety
    Psychology
    Affective Symptoms
    Symptom Assessment
    Cardiomyopathies
    Information Systems
    Fatigue
    Patient Reported Outcome Measures
    Chronic Disease
    Depression
    Health
    Surveys and Questionnaires
    Therapeutics

    Keywords

    • Heart failure
    • Intrathoracic impedance
    • Pulmonary congestion
    • Quality of life
    • Symptom

    ASJC Scopus subject areas

    • Pulmonary and Respiratory Medicine
    • Critical Care and Intensive Care Medicine
    • Cardiology and Cardiovascular Medicine

    Cite this

    Device-detected congestion is associated with worse patient-reported outcomes in heart failure. / Auld, Jonathan P.; Mudd, James; Gelow, Jill; Lyons, Karen; Hiatt, Shirin O.; Lee, Christopher.

    In: Heart and Lung, 01.01.2019.

    Research output: Contribution to journalArticle

    @article{715a23cce4f742ea81c45587c67051bb,
    title = "Device-detected congestion is associated with worse patient-reported outcomes in heart failure",
    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{\circledR} 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 62 years old, 39{\%} were women, and 63{\%} had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days 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 90 days 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 3 months.",
    keywords = "Heart failure, Intrathoracic impedance, Pulmonary congestion, Quality of life, Symptom",
    author = "Auld, {Jonathan P.} and James Mudd and Jill Gelow and Karen Lyons and Hiatt, {Shirin O.} and Christopher Lee",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1016/j.hrtlng.2018.12.003",
    language = "English (US)",
    journal = "Heart and Lung: Journal of Acute and Critical Care",
    issn = "0147-9563",
    publisher = "Mosby Inc.",

    }

    TY - JOUR

    T1 - Device-detected congestion is associated with worse patient-reported outcomes in heart failure

    AU - Auld, Jonathan P.

    AU - Mudd, James

    AU - Gelow, Jill

    AU - Lyons, Karen

    AU - Hiatt, Shirin O.

    AU - Lee, Christopher

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - 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 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days 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 90 days 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 3 months.

    AB - 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 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days 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 90 days 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 3 months.

    KW - Heart failure

    KW - Intrathoracic impedance

    KW - Pulmonary congestion

    KW - Quality of life

    KW - Symptom

    UR - http://www.scopus.com/inward/record.url?scp=85059326133&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85059326133&partnerID=8YFLogxK

    U2 - 10.1016/j.hrtlng.2018.12.003

    DO - 10.1016/j.hrtlng.2018.12.003

    M3 - Article

    JO - Heart and Lung: Journal of Acute and Critical Care

    JF - Heart and Lung: Journal of Acute and Critical Care

    SN - 0147-9563

    ER -