Abstract 2702: Changes in Filling Pressures Rather than in Daily Weights Predict Heart Failure Events with Active Heart Failure Disease Management
Introduction: While active heart failure (HF) disease management (HFM) that includes frequent patient contact and education about symptoms, daily weights, and medication adjustment has been shown to decrease HF events, recurrent HF hospitalization for fluid overload remains frequent. To determine whether HF events that occur despite HFM can still be predicted from changes in serial weights and filling pressures, HF events were analyzed from the COMPASS-HF trial.
Methods and Results: After a recent HF hospitalization and COMPASS-HF study enrollment at 28 experienced HF centers, 274 patients received HF education and averaged 24.7 staff contacts/6 months. HF event rates decreased from 1.9 in the 6 months prior to enrollment to 0.85 and 0.67 during 6 months after enrollment in the study (control and treatment arms, respectively). For 66 HF events, home weights and invasively measured right ventricular diastolic pressures (RVDP) transmitted from home were available from 7 weeks previously and were defined as baseline. RVDP rose steadily from 4 weeks to 1 day prior to the HF event, while weights varied without major increase until 1 day prior (figure⇓). RVDP increased by ≥ 2 mm Hg at least 1 week prior to 39/66 events (59%), while weight gain increased by ≥ 2 pounds at least 1 week prior to 19/66 events (29%).
Conclusions: Events occurring despite HFM, which includes diuretic adjustment for symptoms and weight gain, were predicted by increasing cardiac filling pressures but not by weight gain. In addition to changes in daily weights, increases in filling pressures may guide interventions to avert HF events otherwise not anticipated from routine weights and frequent HFM contact.