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Wearables and non-invasive HF monitoring : fluid status measurements to earlier exacerbation prediction and management
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Resumo(s)
Introdução: Hospitalizações são um problema recorrente em doentes com Insuficiência Cardíaca. Devem ser seguidos no período pós-alta de um internamento, para verificar a existência de sintomas e a necessidade de mudança da dose da terapêutica.
Existem dispositivos implantáveis com grande evidência de serem capazes de detetar a congestão pulmonar que resulta da exacerbação da IC, contudo, poucos pacientes são candidatos para os receber, sendo ainda muito dispendiosos. (Adamson et al., 2017; Alotaibi et al., 2020; Thakker et al., 2022). Seria uma grande ajuda no seguimento, ou mesmo em projetos de telemonitorização, haver medições não invasivas do fluid status que conseguissem detetar o início de uma descompensação. A bioimpedância é um método seguro e rápido de medir a resistência à passagem de correntes elétricas, permitindo estimar a congestão pulmonar.
Métodos: Pesquisa seguindo as guidelines PRISMA, utilizando as bases de dados PubMed e Scopus, que resultou 6 estudos – 3 observacionais e 3 experimentais. Foram usadas as escalas RoB-2, ROBINS-I e PROBAST para avaliar o risco de viés dos estudos.
Resultados: Os estudos observacionais, que utilizam dispositivos portáteis, obtiveram uma alta sensibilidade (85%) e modesta especificidade (54%), sendo esta última melhorada se à monitorização for adicionada outros parâmetros vitais (70%).
Os estudos experimentais, com dispositivos portáteis ou visitas regulares a clínicas de cardiologia, mostraram uma redução das rehospitalizações em cerca de 72%.
Conclusão: Os estudos mostraram resultados muito positivos em conseguir antecipar e reduzir as hospitalizações. Recomenda-se a criação de mais ensaios clínicos randomizados de forma a haver uma evidência robusta da sua capacidade.
Background: Hospitalizations are a recurrent problem in Heart Failure patients. They should be followed up post-discharge to check for symptoms and the need to adjust the therapeutics. Some implantable devices have robust evidence of being able to detect pulmonary congestion resulting from HF exacerbation, however, few are candidates for receiving those, which are also extremely expensive. (Adamson et al., 2017; Alotaibi et al., 2020; Thakker et al., 2022). It would be a great help in heart failure follow-up, or even in telemonitoring projects, to have fluid status non-invasive measurements that could detect the start of a decompensation. Bioimpedance is a quick and secure method of measuring resistance to the passage of electrical currents, allowing the estimation of lung congestion. Methods: Research following the PRISMA guidelines, using PubMed and Scopus databases, which resulted in 6 studies – 3 observational and 3 experimental. RoB-2, ROBINS-I and PROBAST scales were used to assess the risk of bias in the studies. Results: Observational studies, using portable devices, achieved an high sensitivity (85%) and a modest specificity (54%), with the specificity being improved if other vital parameters are added to monitoring (70%). Experimental studies, using portable devices or regular visits to cardiology clinics, have shown a reduction in rehospitalizations by 72%. Conclusion: Very positive results have been shown of being able to anticipate and reduce hospitalizations. It is recommended the creation of more randomized controlled trials to robust the evidence of their capacity.
Background: Hospitalizations are a recurrent problem in Heart Failure patients. They should be followed up post-discharge to check for symptoms and the need to adjust the therapeutics. Some implantable devices have robust evidence of being able to detect pulmonary congestion resulting from HF exacerbation, however, few are candidates for receiving those, which are also extremely expensive. (Adamson et al., 2017; Alotaibi et al., 2020; Thakker et al., 2022). It would be a great help in heart failure follow-up, or even in telemonitoring projects, to have fluid status non-invasive measurements that could detect the start of a decompensation. Bioimpedance is a quick and secure method of measuring resistance to the passage of electrical currents, allowing the estimation of lung congestion. Methods: Research following the PRISMA guidelines, using PubMed and Scopus databases, which resulted in 6 studies – 3 observational and 3 experimental. RoB-2, ROBINS-I and PROBAST scales were used to assess the risk of bias in the studies. Results: Observational studies, using portable devices, achieved an high sensitivity (85%) and a modest specificity (54%), with the specificity being improved if other vital parameters are added to monitoring (70%). Experimental studies, using portable devices or regular visits to cardiology clinics, have shown a reduction in rehospitalizations by 72%. Conclusion: Very positive results have been shown of being able to anticipate and reduce hospitalizations. It is recommended the creation of more randomized controlled trials to robust the evidence of their capacity.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Insuficiência cardíaca Monitorização Wearables Fluid status Bioimpedância Cardiologia