CONTEMPORARY REVIEW
Role of Volume Redistribution in the Congestion of Heart Failure Marat Fudim, MD; Adrian F. Hernandez, MD; G. Michael Felker, MD
In Heart Failure: Congestion Does Not Equal Volume Overload
M
ost of the current heart failure (HF) prevention or management programs assume that cardiovascular decompensations are primarily driven by volume overload that result in cardiopulmonary congestion. Subsequently, a centerpiece of HF therapies is decongestion of the cardiovascular system. Diuretic drug therapies are known to improve HF symptoms, but more aggressive volume removal strategies such as ultrafiltration have not been proven effective in HF.1,2 Current strategies for longitudinal HF management often focus on some form of postdischarge surveillance that targets outpatient weight and volume status trends. Home or remote monitoring efforts commonly rely on daily weight measurements where an acute change in weight would result in a change in medical therapy. The sensitivity of such weight changes prior to hospitalizations were found to be very low (9%), whereas the specificity of such changes is high (97%).3 Notably, many patients do not experience a change in weight before a hospitalization for acute decompensated heart failure (ADHF). In fact, 50% of patients gain an insignificant amount of weight (
Role of Volume Redistribution in the Congestion of Heart Failure Marat Fudim, MD; Adrian F. Hernandez, MD; G. Michael Felker, MD
In Heart Failure: Congestion Does Not Equal Volume Overload
M
ost of the current heart failure (HF) prevention or management programs assume that cardiovascular decompensations are primarily driven by volume overload that result in cardiopulmonary congestion. Subsequently, a centerpiece of HF therapies is decongestion of the cardiovascular system. Diuretic drug therapies are known to improve HF symptoms, but more aggressive volume removal strategies such as ultrafiltration have not been proven effective in HF.1,2 Current strategies for longitudinal HF management often focus on some form of postdischarge surveillance that targets outpatient weight and volume status trends. Home or remote monitoring efforts commonly rely on daily weight measurements where an acute change in weight would result in a change in medical therapy. The sensitivity of such weight changes prior to hospitalizations were found to be very low (9%), whereas the specificity of such changes is high (97%).3 Notably, many patients do not experience a change in weight before a hospitalization for acute decompensated heart failure (ADHF). In fact, 50% of patients gain an insignificant amount of weight (
