This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: October 2, 2007, Volume 116, Number 14 All Versions of this Article: 116/14/1549    most recent CIRCULATIONAHA.107.690768v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Chaudhry, S. I. Articles by Krumholz, H. M. Search for Related Content PubMed PubMed Citation Articles by Chaudhry, S. I. Articles by Krumholz, H. M. Pubmed/NCBI databases Medline Plus Health Information Heart Failure Related Collections Congestive

(Circulation. 2007;116:1549-1554.)
© 2007 American Heart Association, Inc.

Heart Failure

Patterns of Weight Change Preceding Hospitalization for Heart Failure

Sarwat I. Chaudhry, MD; Yongfei Wang, MS; John Concato, MD, MPH; Thomas M. Gill, MD; Harlan M. Krumholz, MD, SM

From the Department of Internal Medicine, Sections of General Medicine (S.I.C., J.C.), Cardiovascular Medicine (Y.W., H.M.K.), and Geriatric Medicine (T.M.G.), Department of Epidemiology and Public Health, Sections of Chronic Disease Epidemiology (T.M.G.) and Health Policy and Administration (H.M.K.), and The Robert Wood Johnson Clinical Scholars Program (H.M.K.), Yale University School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation (Y.W., H.M.K.), Yale New Haven Hospital, New Haven, Conn; and Clinical Epidemiology Research Center (J.C.), VA Connecticut Healthcare System, West Haven, Conn.

Correspondence to Sarwat Chaudhry, MD, Yale School of Medicine, 15 York St, Room DC 013K, PO Box 208025, New Haven, CT 06520. E-mail sarwat.chaudhry{at}yale.edu

Received January 16, 2007; accepted July 19, 2007.

Background— Weight gain is used by disease-management programs as a marker of heart failure decompensation, but little information is available to quantify the relationship between weight change in patients with heart failure and the risk for imminent hospitalization.

Methods and Results— We conducted a nested case-control study among patients with heart failure referred to a home monitoring system by managed care organizations. We matched 134 case patients with heart failure hospitalization to 134 control patients without heart failure hospitalization on the basis of age, sex, duration of home monitoring, heart failure severity, and baseline body weight. Compared with control patients, case patients experienced gradual weight gain beginning 30 days before hospitalization; changes in daily weight between case and control patients were statistically significant (P<0.001). Within the week before hospitalization, when weight patterns in case and control patients began to diverge more substantially, mean increases of more than 2 and up to 5 pounds, more than 5 and up to 10 pounds, and more than 10 pounds (relative to time of enrollment in the monitoring system) were associated with matched adjusted odds ratios for heart failure hospitalization of 2.77 (95% confidence interval 1.13 to 6.80), 4.46 (95% confidence interval 1.45 to 13.75), and 7.65 (95% confidence interval 2.22 to 26.39), respectively, compared with mean increases of 2 pounds or less.

Conclusions— Increases in body weight are associated with hospitalization for heart failure and begin at least 1 week before admission. Daily information about patients’ body weight identifies a high-risk period during which interventions to avert decompensated heart failure that necessitates hospitalization may be beneficial.

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