Non-invasive Lung IMPEDANCE-Guided Preemptive Treatment in Chronic Heart Failure Patients - IMPEDANCE-HF

Description:

The goal of the trial was to evaluate the efficacy of lung impedance–guided treatment in reducing congestive heart failure (CHF) hospitalizations.

Contribution to the Literature: This study suggests that noninvasive lung impedance–guided management is superior to routine management in reducing CHF hospitalizations at 1 year and beyond.



Study Design

Patients with CHF with reduced ejection fraction (HFrEF) were randomized in a 1:1 fashion to either noninvasive lung impedance–guided management (n = 128) or routine management (n = 128).

Inclusion criteria:

  • CHF patients
  • Left ventricular EF ≤35%
  • New York Heart Association class II-IV

  • Total number of enrollees: 256
  • Duration of follow-up: 12 months
  • Mean patient age: 67 years
  • Percentage female: 20%

Principal Findings:

The primary outcome, rate of hospitalization at 1 year for lung–impedance guided arm vs. routine management, was 0.52 vs. 1.23 per patient-year, p < 0.001.

Secondary outcomes:

  • Significant reductions noted in all-cause and cardiac mortality with lung–impedance guidance (p < 0.001 for both)
  • Important change observed in rate of change in medical therapy during entire follow-up (furosemide, beta-blockers, angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker, etc., p < 0.05)

Interpretation:

The results of this trial indicate that noninvasive lung-impedance guided management is superior to routine management in reducing CHF hospitalizations at 1 year and beyond. This was a small proof-of-concept study done at two centers. Future studies will need to validate these findings in a larger multicenter setting. Further details regarding the device, implantation methods, cost, safety, etc., also need to be carefully assessed. Remote monitoring for CHF has gained a lot of attention recently; the CardioMEMS HF System (which senses increases in pulmonary artery pressures) was recently approved for this indication.

References:

Shochat MK, Shotan A, Blondheim DS, et al. Non-Invasive Lung IMPEDANCE-Guided Preemptive Treatment in Chronic Heart Failure Patients: a Randomized Controlled Trial (IMPEDANCE-HF Trial). J Card Fail 2016;Apr 4:[Epub ahead of print].

Presented by Dr. Michael Shochat at the American College of Cardiology Annual Scientific Session, Chicago, IL, April 4, 2016.


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