Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failure

作者：Dirk J. van Veldhuisen, Frieder Braunschweig, Viviane Marie Conraads, Ian Ford, Martín Cowie, Guillaume Jondeau, Josef Kautzner, Roberto Muñoz Aguilera, Maurizio Lunati, Cheuk‐Man Yu, Bart Gerritse, Martin Borggrefe, for the DOT-HF Investigators · 发表于：Circulation · 年份：2011 · DOI：10.1161/circulationaha.111.043042 · 被引用次数：447 · 研究领域：Cardiac pacing and defibrillation studies、Healthcare Technology and Patient Monitoring、Heart Failure Treatment and Management

BACKGROUND: Heart failure is associated with frequent hospitalizations, often resulting from volume overload. Measurement of intrathoracic impedance with an implanted device with an audible patient alert may detect increases in pulmonary fluid retention early. We hypothesized that early intervention could prevent hospitalizations and affect outcome. METHODS AND RESULTS: We studied 335 patients with chronic heart failure who had undergone implantation of an implantable cardioverter-defibrillator alone (18%) or with cardiac resynchronization therapy (82%). All devices featured a monitoring tool to track changes in intrathoracic impedance (OptiVol) and other diagnostic parameters. Patients were randomized to have information available to physicians and patients as an audible alert in case of preset threshold crossings (access arm) or not (control arm). The primary end point was a composite of all-cause mortality and heart failure hospitalizations. During 14.9±5.4 months, this occurred in 48 patients (29%) in the access arm and in 33 patients (20%) in the control arm (P=0.063; hazard ratio, 1.52; 95% confidence interval, 0.97-2.37). This was due mainly to more heart failure hospitalizations (hazard ratio, 1.79; 95% confidence interval, 1.08-2.95; P=0.022), whereas the number of deaths was comparable (19 versus 15; P=0.54). The number of outpatient visits was higher in the access arm (250 versus 84; P<0.0001), with relatively more signs of heart failure among control patients duri...