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

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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)208-214
Number of pages7
JournalHeart and Lung
Volume48
Issue number3
DOIs
StatePublished - May 1 2019

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

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