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Heart Lung. 2019 Jan 2. pii: S0147-9563(18)30358-3. doi: 10.1016/j.hrtlng.2018.12.003. [Epub ahead of print]

Device-detected congestion is associated with worse patient-reported outcomes in heart failure.

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Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA. Electronic address:
Oregon Health & Science University, Knight Cardiovascular Institute, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA.
Oregon Health & Science University School of Nursing, 3455 SW US Veterans Hospital Rd., SN-ADM, Portland, OR 97239-2941, USA.
William F. Connell School of Nursing, Boston College, Maloney Hall, 231140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.



Congestion is a common cause of symptoms in heart failure (HF). Yet, intrathoracic impedance, an objective marker of cardiopulmonary congestion, has not been examined in relation to HF symptoms.


To determine whether device-detected cardiopulmonary congestion is a predictor of physical and psychological symptoms and health-related quality of life (HRQOL) in adults with HF over 3 months.


Multivariate generalized linear modeling was used to quantify the association of cardiopulmonary congestion (Optivol® Index exceeding 60 Ω threshold) with HRQOL (12-item Kansas City Cardiomyopathy Questionnaire) and both physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early & Subtle Symptoms subscales) and affective symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale).


The mean age of the sample (n = 49) was 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Participants who experienced threshold crossings in the previous 90 days reported on average, 130% higher dyspnea (p = 0.017; confidence interval (CI) 10.2%, 437%), 40% higher early & subtle symptoms (p = 0.029; CI 3.4%, 89.7%), 106% higher depressive symptoms (p = 0.003; CI 19.1%, 257%) and 40% higher anxiety (p = 0.028; CI 3.7%, 89.1%). Threshold crossings in the previous 90 days were also significantly associated with a clinically meaningful decrease in HRQOL (β = -16.16 ± 6.32; p = 0.01).


Intrathoracic impedance measured with the Optivol Index can provide additional information regarding the patient experience of hallmark physical and psychological HF symptoms and HRQOL over 3 months.


Heart failure; Intrathoracic impedance; Pulmonary congestion; Quality of life; Symptom

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