@Article{info:doi/10.2196/medinform.4842,
author="Cuba Gyllensten, Illapha
and Bonomi, Alberto G
and Goode, Kevin M
and Reiter, Harald
and Habetha, Joerg
and Amft, Oliver
and Cleland, John GF",
title="Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance",
journal="JMIR Med Inform",
year="2016",
month="Feb",
day="18",
volume="4",
number="1",
pages="e3",
keywords="Heart failure; telemonitoring; deterioration detection; alert algorithms; ambulatory monitoring; impedance",
abstract="Background: Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective: In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods: We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results: Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33{\%}, NITTI-CUSUM: 60{\%}) in contrast to the simpler rules-of-thumb (Weight-RoT: 20{\%}, NITTI-RoT: 33{\%}) as proposed in HF guidelines. Conclusions: NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation. ",
issn="2291-9694",
doi="10.2196/medinform.4842",
url="http://medinform.jmir.org/2016/1/e3/",
url="https://doi.org/10.2196/medinform.4842",
url="http://www.ncbi.nlm.nih.gov/pubmed/26892844"
}