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Early and personalized ambulatory follow-up to tailor furosemide and fluid intake according to congestion in post-discharge heart failure

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Abstract

Congestive heart failure (CHF) worsening is a worldwide cause of rehospitalization and mortality, specially during the early period after hospitalization. Fluid accumulation plays a key role in the pathophysiology of both acute heart decompensation and disease progression. The effective use of drugs to maintain restored clinical stabilization in recently discharged patients is a difficult task, and it relies on matching the most appropriately tailored therapy to specific clinical profiles. However, no successful treatment has been shown to reduce post-discharge readmission. We evaluated in a case-control study the effectiveness of an early and personalized congestion-guided ambulatory program on medium-term (6 months) compensation in recently discharged CHF patients. Group A (22 patients) underwent a post-discharge close follow-up consisting of: an early clinic visit within 10 days; a second visit within 10 days after the first; and the other visits at month 1, 2, 3 after discharge. Controls (Group B, 21 patients) underwent a conventional ambulatory follow-up only at month 1, 2, 3 after discharge. The ambulatory approach in both groups was based on the monitoring of signs/symptoms of congestion and body weight, body hydration estimation by using bioelectrical impedance analysis (BIA) and laboratory data. This assessment was finalized to tailor furosemide and daily fluid intake at each visit to eliminate clinical or instrumental evidence of persistent congestion relieving the signs and symptoms. At 6 months, Group A was associated with a better clinical compensation (improved hydration state, lower BNP levels and congestion score), an improved quality of life, and reduced re-hospitalizations. We conclude that in CHF the early and personalized ambulatory follow-up based on congestion-guided treatment is effective to optimize management and maintain clinical stability in the post-discharge period.

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Authors and Affiliations

  1. Biomedical Department of Internal and Specialty Medicine (Di.Bi.Mi.S.), Division of Internal Medicine and Cardioangiology, Heart Failure Out-Patients Clinic, A.O.U.Policlinico “Paolo Giaccone”, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy

    Gaspare Parrinello, Daniele Torres, Salvatore Paterna, Caterina Trapanese, Mauro Cardillo, Michele Bellanca & Giuseppe Licata

  2. Division of Cardiology “Paolo Borsellino”, G.F. Ingrassia Hospital, Palermo, Italy

    Pietro Di Pasquale & Sergio Fasullo

Authors
  1. Gaspare Parrinello
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  2. Daniele Torres
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  3. Salvatore Paterna
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  4. Pietro Di Pasquale
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  5. Caterina Trapanese
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  6. Mauro Cardillo
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  7. Michele Bellanca
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  8. Sergio Fasullo
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  9. Giuseppe Licata
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Correspondence to Daniele Torres.

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Parrinello, G., Torres, D., Paterna, S. et al. Early and personalized ambulatory follow-up to tailor furosemide and fluid intake according to congestion in post-discharge heart failure. Intern Emerg Med 8, 221–228 (2013). https://doi.org/10.1007/s11739-011-0602-y

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  • DOI: https://doi.org/10.1007/s11739-011-0602-y

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