Heart Failure is a complex disease with a high mortality, very costly, and is associated with ruining the quality of life. Heart failure is a serious condition. About 5 million people in the U.S. have heart failure. It contributes to 300,000 deaths each year.
The most significant costs are associated with hospitalizations which occur when the heart no longer can compensate, and the patient becomes symptomatic. The symptoms are usually due to the excess fluid which is accumulating all over the body, as the heart’s effectiveness falters. The excess fluid causes edema in the lower extremities, shortness of breath, and extreme fatigue. The patient’s hospitalized treatment consists of many expensive procedures and drugs to get the heart back into a functioning state, and reduce symptoms. The patient is then discharged, ready to repeat this process all over again, probably in the near future. Heart failure (HF) is the number one reason for hospitalization in people over the age of 65 years old.
Self-monitoring of one’s weight and frequent reports to the physician has been the method of choice for years to spot impending decompensation. Weight gain has typically been associated with the build of fluid when the heart’s pumping action becomes sluggish. This type of monitoring is often inaccurate, as patients do not give accurate reports, do not follow through on weight gain orders, have significant denial of the severity of their condition so don’t implement physician recommendations, etc..
Recently, however, an implantable intrathoracic impedance monitor was approved by the US Food and Drug Administration (FDA) and shows promise in its ability to provide more accurate monitoring of our HF patients. “The concept of bioimpedance originated in the 1960s, when the University of Minnesota partnered with the National Aeronautics Space Administration (NASA) to evaluate the effects of a gravity-free environment on astronauts. Thoracic bioimpedance involves the measurement of changes in the resistance to the flow of electricity through the thorax. Changes in resistance -- or, more properly, impedance -- may be used to identify alterations in fluid content and hemodynamic status. This phenomenon is based on the principle that electricity travels better through water than it does through air. Relative to air, water is a conductor and, therefore, air may be considered an insulator.”
Transthoracic impedance is measured between the coil of the right ventricular lead and the can of the cardiac resynchronisation therapy (CRT) device or implanted cardioverter defibrillator (ICD). This measurement is made multiple times each day and recorded for up to 14 months. The device can be interrogated in detail by a technician, or at a more basic level by either the patient or physician using a simple hand-held device.
In the future, physicians will be able to electronically monitor their patient’s condition based on wet or dry lung, versus the present subjective and crude system of weight gain. Resulting hospitalizations should be decreased, costs decreased, and hopefully, the quality of the patient’s life improved as a result of preventing heart decompensation and all of its adverse symptoms.
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