John D Groarke1, Susanna R Stevens2, Robert J Mentz2, Lauren B Cooper2, Justin M Vader3, Omar F AbouEzzeddine4, Justin L Grodin5, Emer Joyce5, Kevin J Anstrom2, G Michael Felker2, Margaret M Redfield4, Lynne Warner Stevenson1, Anuradha Lala6. 1. Brigham and Women's Hospital, Division of Cardiology, Boston, Massachusetts. 2. Duke Clinical Research Institute, Durham, North Carolina. 3. Washington University, Division of Cardiology, St. Louis, Missouri. 4. Mayo Clinic, Division of Cardiology, Rochester, Minnesota. 5. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 6. Brigham and Women's Hospital, Division of Cardiology, Boston, Massachusetts; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, Icahn School of Medicine, New York, New York. Electronic address: anu.lala@mountsinai.org.
Abstract
AIMS: To explore the association of changes in weight and fluid during treatment for acute heart failure (AHF) with clinical endpoints. METHODS AND RESULTS: Weight and net fluid changes recorded at 72-96 hours in 708 AHF patients enrolled in Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure, Cardiorenal Rescue Study in Acute Decompensated Heart Failure, and Renal Optimization Strategies Evaluation in Acute Heart Failure studies were compared with freedom from congestion at 72-96 hours and a composite endpoint of death, rehospitalization, and unplanned hospital visit at 60 days. Weight loss was concordant with net fluid loss in 55%, discordant and less than expected for fluid loss in 34%, and paradoxically discordant or more than expected for fluid loss in 11% of patients. Weight loss, but not fluid loss, was associated with freedom from congestion (odds ratio per 1-kg weight loss = 1.11 [1.03-1.19]) and a nominal reduction in the composite endpoint (hazard ratio per 1-kg weight loss = 0.98 [0.95-1.00]). Outcomes were similar in patients with concordant and discordant weight-fluid loss. CONCLUSION: During treatment for AHF, early changes in weight may be more useful for identifying response to therapy and for predicting outcomes than net fluid output. Nearly one-half of patients receiving decongestive therapies demonstrate discordant changes in weight and fluid; however, discordance was not associated with outcomes.
AIMS: To explore the association of changes in weight and fluid during treatment for acute heart failure (AHF) with clinical endpoints. METHODS AND RESULTS: Weight and net fluid changes recorded at 72-96 hours in 708 AHF patients enrolled in Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure, Cardiorenal Rescue Study in Acute Decompensated Heart Failure, and Renal Optimization Strategies Evaluation in Acute Heart Failure studies were compared with freedom from congestion at 72-96 hours and a composite endpoint of death, rehospitalization, and unplanned hospital visit at 60 days. Weight loss was concordant with net fluid loss in 55%, discordant and less than expected for fluid loss in 34%, and paradoxically discordant or more than expected for fluid loss in 11% of patients. Weight loss, but not fluid loss, was associated with freedom from congestion (odds ratio per 1-kg weight loss = 1.11 [1.03-1.19]) and a nominal reduction in the composite endpoint (hazard ratio per 1-kg weight loss = 0.98 [0.95-1.00]). Outcomes were similar in patients with concordant and discordant weight-fluid loss. CONCLUSION: During treatment for AHF, early changes in weight may be more useful for identifying response to therapy and for predicting outcomes than net fluid output. Nearly one-half of patients receiving decongestive therapies demonstrate discordant changes in weight and fluid; however, discordance was not associated with outcomes.
Authors: Jonathan W Cunningham; Jie-Lena Sun; Finnian R Mc Causland; Samantha Ly; Kevin J Anstrom; Joann Lindenfeld; Michael M Givertz; Lynne W Stevenson; Neal K Lakdawala Journal: Clin Cardiol Date: 2019-11-12 Impact factor: 2.882
Authors: Anuradha Lala; Maya H Barghash; Gennaro Giustino; Jesus Alvarez-Garcia; Swiri Konje; Aditya Parikh; Jennifer Ullman; Brendan Keith; John Donehey; Sumeet S Mitter; Maria Giovanna Trivieri; Johanna P Contreras; Daniel Burkhoff; Noah Moss; Donna M Mancini; Sean P Pinney Journal: ESC Heart Fail Date: 2020-12-18