Author + information
- Received May 3, 2018
- Revision received May 30, 2018
- Accepted June 27, 2018
- Published online October 10, 2018.
- aHeart-Lung Center, Hawthorne, New Jersey
- bDaxor Corporation, New York, New York
- cDepartment of Cardiovascular Diseases, Division of Circulatory Failure, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. John E. Strobeck, Heart-Lung Center, 59 West Saddle River Road, Saddle River, New Jersey 07458.
Objectives This study performed a retrospective outcome analyses of a large cohort of mixed ejection fraction patients admitted for acute heart failure (HF), whose inpatient care was guided by individual quantitative blood volume analysis (BVA) results.
Background Decongestion strategies in patients hospitalized for HF are based on clinical assessment of volume and have not integrated a quantitative intravascular volume metric.
Methods Propensity score control matching analysis was performed in 245 consecutive HF admissions to a community hospital (September 2007 to April 2014; 78 ± 10 years of age; 50% with HF with reduced ejection fraction [HFrEF]; and 30% with Stage 4 chronic kidney disease). Total blood volume (TBV), red blood cell volume (RBCV), and plasma volume (PV) were measured at admission by using iodine-131-labeled albumin indicator-dilution technique. Decongestion strategy targeted a TBV threshold of 6% to 8% above patient-specific normative values. Anemia was treated based on cause. Hematocrit (Hct) measurements were monitored to assess effectiveness of interventions. Control subjects derived from Centers for Medicare and Medicaid Services data were matched 10:1 for demographics, comorbidity, and year of treatment.
Results Although 66% of subjects had PV expansion, only 37% were hypervolemic (TBV >10% excess). True anemia (RBCV ≥10% deficit) was present in 62% of subjects. Treatment of true anemia without hypervolemia resulted in a rise in peripheral Hct of 2.7 ± 2.9% (p < 0.001), and diuretic treatment of hypervolemia in cases without anemia caused a 4.5 ± 3.9% (p < 0.001) increase in peripheral Hct at 11.3 ± 7.5 days after admission. Subjects had lower 30-day rates of readmission (12.2% vs. 27.7%, respectively; p < 0.001), of 30-day mortality (2.0% vs. 11.1%, respectively; p < 0.001), and of 365-day mortality (4.9% vs. 35.5%, respectively; p < 0.001) but longer lengths of stay (7.3 vs. 5.6 days, respectively; p < 0.001) than control subjects.
Conclusions Retrospective outcomes using volume-guided HF therapy versus propensity-matched controls support the benefit of BVA in guiding volume management and reducing death and rehospitalization due to HF.
Mr. Feldschuh is Chief Scientific Officer of Daxor Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2018.
- Revision received May 30, 2018.
- Accepted June 27, 2018.
- 2018 American College of Cardiology Foundation
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