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Alvarez-Garcia J, Lala A, Rivas-Lasarte M, De Rueda C, Brunjes D, Lozano-Jimenez S, Garcia-Sebastian C, Mitter S, Remior P, Jimenez-Blanco Bravo M, Del Prado S, Barghash M, González-Ferrer E, Ullman J, Cobo M, Segovia-Cubero J, Zamorano JL, Pinney SP, Mancini D. Remote Dielectric Sensing Before and After Discharge in Patients With ADHF: The ReDS-SAFE HF Trial. JACC. HEART FAILURE 2024; 12:695-706. [PMID: 38430084 DOI: 10.1016/j.jchf.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Incomplete treatment of congestion often leads to worsening heart failure (HF). The remote dielectric sensing (ReDS) system is an electromagnetic energy-based technology that accurately quantifies changes in lung fluid concentration noninvasively. OBJECTIVES This study sought to assess whether an ReDS-guided strategy during acutely decompensated HF hospitalization is superior to routine care for improving outcomes at 1 month postdischarge. METHODS ReDS-SAFE HF (Use of ReDS for a SAFE discharge in patients with acute Heart Failure) was an investigator-initiated, multicenter, single-blind, randomized, proof-of-concept trial in which 100 patients were randomized to a routine care strategy, with discharge criteria based on current clinical practice, or an ReDS-guided decongestion strategy, with discharge criteria requiring an ReDS value of ≤35%. ReDS measurements were performed daily and at a 7-day follow-up visit, with patients and treating physicians in the routine care arm blinded to the results. The primary outcome was a composite of unplanned visits for HF, HF rehospitalization, or death at 1 month after discharge. RESULTS The mean age was 67 ± 14 years, and 74% were male. On admission, left ventricular ejection fraction was 37% ± 16%, and B-type natriuretic peptide was 940 pg/L (Q1-Q3: 529-1,665 pg/L). The primary endpoint occurred in 10 (20%) patients in the routine care group and 1 (2%) in the ReDS-guided strategy group (log-rank P = 0.005). The ReDS-guided strategy group experienced a lower event rate, with an HR of 0.094 (95% CI: 0.012-0.731; P = 0.003), and a number of patients needed to treat of 6 to avoid an event (95% CI: 3-17), mainly resulting from a decrease in HF readmissions. The median length of stay was 2 days longer in the ReDS-guided group vs the routine care group (8 vs 6; P = 0.203). CONCLUSIONS A ReDS-guided strategy to treat congestion improved 1-month prognosis postdischarge in this proof-of-concept study, mainly because of a decrease of the number of HF readmissions. (Use of ReDS for a SAFE discharge in patients with acute Heart Failure [ReDS-SAFE HF]; NCT04305717).
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Affiliation(s)
- Jesus Alvarez-Garcia
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain.
| | - Anuradha Lala
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA.
| | - Mercedes Rivas-Lasarte
- Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Clemencia De Rueda
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Danielle Brunjes
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
| | - Sara Lozano-Jimenez
- Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Cristina Garcia-Sebastian
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Sumeet Mitter
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
| | | | - Marta Jimenez-Blanco Bravo
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Susana Del Prado
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Maya Barghash
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
| | - Eduardo González-Ferrer
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Jennifer Ullman
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
| | - Marta Cobo
- Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - Javier Segovia-Cubero
- Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain
| | - José Luis Zamorano
- Ramon y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Sean P Pinney
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
| | - Donna Mancini
- Mount Sinai Hospital, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, New York, USA
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Sawalha K, Norgard NB, Drees BM, López-Candales A. Growth Differentiation Factor 15 (GDF-15), a New Biomarker in Heart Failure Management. Curr Heart Fail Rep 2023; 20:287-299. [PMID: 37289373 DOI: 10.1007/s11897-023-00610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
The emergence of biomarkers across medicine's subspecialties continues to evolve. In essence, a biomarker is a biological observation that clearly substitutes a clinical endpoint or intermediate outcome not only are more difficult to observe but also, biomarkers are easier, less expensive and could be measured over shorter periods. In general, biomarkers are versatile and not only used for disease screening and diagnosis but, most importantly, for disease characterization, monitoring, and determination of prognosis as well as individualized therapeutic responses. Obviously, heart failure (HF) is no exception to the use of biomarkers. Currently, natriuretic peptides are the most used biomarkers for both diagnosis and prognostication, while their role in the monitoring of treatment is still debatable. Although several other new biomarkers are currently under investigation regarding diagnosis and determination of prognosis, none of them are specific for HF, and none are recommended for routine clinical use at present. However, among these emerging biomarkers, we would like to highlight the potential for growth differentiation factor (GDF)-15 as a plausible new biomarker that could be helpful in providing prognostic information regarding HF morbidity and mortality.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Medicine Fellowship, University of Missouri-Kansas City, Kansas City, MO, USA.
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA.
| | - Nicholas B Norgard
- Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Betty M Drees
- Department(s) of Internal Medicine, Biomedical and Health Informatics, Section of Endocrinology, UMKC School of Medicine, Kansas City, MO, USA
| | - Angel López-Candales
- Section of Cardiovascular Medicine, University Health, Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA
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Abstract
The most challenging feature of heart failure (HF) still remains the evaluation of congestion. Residual congestion at discharge and the difficulties in perfectly dosing therapies in order to balance the hydration status of the patient are the most worrisome issues when dealing with HF.The use of bioimpedance vector analysis (BIVA) might promote a different approach in the general management of patients with HF. BIVA is a reliable, fast, bedside tool able to assess the congestion status. It proved to be helpful to physicians for diagnosing congestive status, managing therapies, and providing prognostic information in the setting of HF.Bioelectrical Phase Angle (PhA) - as derived from equations related to the parameters of BIVA - recently surged as a possible biomarker for patients with HF. Studies provided data about the application of PhA in the clinical management and in the overall risk stratification of HF patients.Basically, the use of PhA might be considered as a holistic evaluation of patients with HF which includes the need for a multiparametric approach able to effectively depict the clinical status of patients. There is no definite biomarker able to comprehensively describe and identify all the features of HF patient, but scores based on molecules/techniques able to explore the different pathogenetic mechanisms of HF are desirable.The aim of this review was to provide a comprehensive evaluation of literature related to PhA role in HF and the impact of this biomarker on clinical management and risk stratification of HF patients.
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Affiliation(s)
- Pietro Scicchitano
- Cardiology Section, F. Perinei Hospital, SS 96 Altamura-Gravina Km 73, 800 - 70022, Altamura, Bari, Italy.
| | - Francesco Massari
- Cardiology Section, F. Perinei Hospital, SS 96 Altamura-Gravina Km 73, 800 - 70022, Altamura, Bari, Italy
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