Oedema index trajectories at heart failure nurse clinics over 6 months after acute heart failure predict patient outcomes: a retrospective cohort study

AIMS: Fluid accumulation is associated with poor outcomes in patients with heart failure (HF). After acute HF, HF nurses provide home care suggestions based on oedema status assessed at outpatient clinics. However, the pattern of serial oedema changes and their associations with patient outcomes are unknown. We investigated the trajectories of bioimpedance analysis (BIA)-derived oedema index (EI) changes following acute HF and their prognostic value.

METHODS AND RESULTS: This was a retrospective cohort study. We recruited 761 patients hospitalized for HF. Multisegmented and multifrequency BIA-derived EIs were measured at HF nurse outpatient clinics after discharge for 6 months. We explored the trajectories of EIs and their associations with all-cause rehospitalization and death within 2 years. Four EI trajectories were identified: trajectory 1 [T1, no oedema, n = 181 (23.8%)], T2 [transient, n = 341 (44.8%)], T3 [fluctuation, n = 195 (25.6%)], and T4 [worsening, n = 44 (5.8%)]. Compared with the T1 group, the T3 and T4 groups included more females; were older; had higher natriuretic peptide and glycohaemoglobin levels; and had higher incidences of comorbidities but lower albumin and cholesterol and worse kidney function (all P < 0.05). The Kaplan-Meier survival curves showed that T2, T3, and T4 patients had lower event-free survival rates than did T1 patients (all P < 0.01). Multivariable analysis demonstrated that T3 and T4 were independently associated with an increased risk for events (P < 0.001).

CONCLUSION: During the 6-month outpatient period after hospitalization, the EI trajectory of fluctuation or worsening was associated with poor outcomes. In the post-acute phase, monitoring the EI trajectory helps identify high-risk patients for optimizing HF management.