[Possibilities of instrumental determination of volemic status in patients with acute decompensation of chronic heart failure].

AIM: To evaluate and compare the accuracy of volemic status determination by remote dielectric sensing with computed tomography (CT) in patients with acute decompensated heart failure. MATERIALS AND METHODS: In 28 patients volemic status was determined by ReDS (remote dielectric sensing), chest computed tomography (CCT), and chest X-ray twice during hospitalization (the day of admission and the day of discharge from the hospital). The ReDS measurements were then compared with CT data using software that allows the use of semi-automated tools to determine mean lung density (MLD). MLD results from Hounsfield Units [HU] were then converted to fluid levels (FU%), allowing them to be compared with ReDS values. In addition, to assess the effect of physical activity on the dynamics of pulmonary stasis there was performed 6-minute walk test (6MWT) followed by determination of volumic status by ReDS method. RESULTS: Correlation analysis revealed an average direct significant correlation (r=+0,5; p=0.001) between the CCT and ReDS data. Hypervolemia indexes according to the CCT revealed statistically significant decrease in the dynamics, which was also reflected in the ReDS index decrease. Lung fluid content according to ReDS averaged 38.2±4.6% on admission, and 34.5±3.9% on discharge (p=0.005). According to CT scan of the CCT, MLD at admission was 23.03±3.9%, at discharge 19.6±3.3% (p=0.003). The positive dynamics of the study methods was also reflected in the positive dynamics of NT-proBNP, which decreased by 46%. In the analysis of ReDS data before and after exercise, there was an increase in ReDS value after the performed 6MWT and it was 35.09±3.9% compared with the initial value of 34.5±3.9%. A strong direct significant correlation (r=+0.7; p=0.0001) was found between the ReDS before and after 6MWT at discharge.

Remote dielectric sensing for detecting pulmonary edema in the emergency department.

BACKGROUND: Dyspnea is a common Emergency Department (ED) complaint of which acute pulmonary edema (APE) is a potentially life-threatening etiology. Remote Dielectric Sensing (ReDS™) is a novel, non-invasive, radar based, rapid, point of care vest testing system used to objectively quantify lung fluid content and may be useful in the early diagnosis of APE. OBJECTIVE: To determine the accuracy of ReDS to detect pathologic lung fluid in ED undifferentiated dyspneic patients. METHODS: We performed a prospective convenience sample observation pilot study enrolling adult ED patients with a chief complaint of "shortness of breath." After informed consent, patients were fitted with the ReDS vest and a reading, blinded to the care team, was recorded. A gold standard diagnosis of pulmonary edema, determined by 2 physicians performing a chart review and blinded to ReDs data, was compared to the ReDS reading. RESULTS: Overall, 123 patients were included; 59% (n = 73) were male, mean (SD) age 57.2 (±12) years, 46.3% (n = 57) Hispanic, 34.1%(n = 42) African American, 13.0% (n = 16) Caucasian and 5.7% (n = 7) Asian. The gold standard diagnosis showed pulmonary edema in 38 (30.9%) patients, of which 30 were detected by ReDS. At an optimal cutoff (≥ 37%), ReDS had a Sn of 79.5% (CI 63.5% - 90.5%), Sp of 72.6% (CI 61.8% - 81.8%), a PPV of 57.4% and a NPV of 88.4%. CONCLUSIONS: ReDS is moderately sensitive and specific with an accuracy of 74.8% for pulmonary edema.

Remote Dielectric Sensing Before and After Discharge in Patients With ADHF: The ReDS-SAFE HF Trial.

BACKGROUND: Incomplete treatment of congestion often leads to worsening heart failure (HF). The remote dielectric sensing (ReDS) system is an electromagnetic energy-based technology that accurately quantifies changes in lung fluid concentration noninvasively. OBJECTIVES: This study sought to assess whether an ReDS-guided strategy during acutely decompensated HF hospitalization is superior to routine care for improving outcomes at 1 month postdischarge. METHODS: ReDS-SAFE HF (Use of ReDS for a SAFE discharge in patients with acute Heart Failure) was an investigator-initiated, multicenter, single-blind, randomized, proof-of-concept trial in which 100 patients were randomized to a routine care strategy, with discharge criteria based on current clinical practice, or an ReDS-guided decongestion strategy, with discharge criteria requiring an ReDS value of ≤35%. ReDS measurements were performed daily and at a 7-day follow-up visit, with patients and treating physicians in the routine care arm blinded to the results. The primary outcome was a composite of unplanned visits for HF, HF rehospitalization, or death at 1 month after discharge. RESULTS: The mean age was 67 ± 14 years, and 74% were male. On admission, left ventricular ejection fraction was 37% ± 16%, and B-type natriuretic peptide was 940 pg/L (Q1-Q3: 529-1,665 pg/L). The primary endpoint occurred in 10 (20%) patients in the routine care group and 1 (2%) in the ReDS-guided strategy group (log-rank P = 0.005). The ReDS-guided strategy group experienced a lower event rate, with an HR of 0.094 (95% CI: 0.012-0.731; P = 0.003), and a number of patients needed to treat of 6 to avoid an event (95% CI: 3-17), mainly resulting from a decrease in HF readmissions. The median length of stay was 2 days longer in the ReDS-guided group vs the routine care group (8 vs 6; P = 0.203). CONCLUSIONS: A ReDS-guided strategy to treat congestion improved 1-month prognosis postdischarge in this proof-of-concept study, mainly because of a decrease of the number of HF readmissions. (Use of ReDS for a SAFE discharge in patients with acute Heart Failure [ReDS-SAFE HF]; NCT04305717).

Effect of measurement procedure errors on assessing lung fluid via remote dielectric sensing system.

The study assessed the impact of procedural errors on the remote dielectric sensing system (ReDS), a non-invasive lung fluid assessment technology, in an Asian cohort. Healthy volunteers underwent ReDS measurements following manufacturer's instructions, with two consecutive measurements one minute apart. A subset of 20 participants had modified procedure settings. Reliability was measured using intraclass correlation coefficient (ICC). The study included 86 healthy volunteers, and all ReDS measurements fell within the recommended normal range. The intra-rater reliability of ReDS measurements was excellent, with an ICC of 0.968. Among the subset of 20 subjects, deviations in height and weight did not significantly affect ReDS values. However, deviations in chest size by ± 3 cm had a noticeable impact on ReDS measures, and incorrect station selection led to fluctuations in ReDS readings. In conclusion, the ReDS system demonstrated excellent intra-rater reliability and applicability in an Asian cohort. Procedural errors, such as chest size measurement and station selection, significantly influenced ReDS measurements. Adherence to standardized operating procedures is crucial to ensure accurate and consistent results. These findings highlight the importance of adherence to manufacturer instructions when utilizing ReDS for lung fluid assessment, thereby enhancing its reliability and clinical applicability.

Clinical implications of remote dielectric sensing system to estimate lung fluid levels.

The reduction of pulmonary congestion is an essential clinical target in the management of chronic heart failure. This proves to be challenging given the lack of a gold standard method to quantify the degree of pulmonary congestion both quickly and non-invasively. Remote dielectric sensing (ReDS) is a non-invasive electromagnetic energy-based technology to quantify lung fluid levels as a percentage within minutes. This technique, due to its high negative predictive value, may be a useful tool particularly to rule out primarily cardiac causes of dyspnea in ambulatory patients when the values are normal. Further studies are warranted to establish ReDS-guided management of congestive heart failure patients.

Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility.

Hospitals and skilled nursing facilities (SNFs) are incentivized to reduce hospital readmissions among patients with heart failure (HF). We used the RE-AIM framework and mixed quantitative and qualitative data to evaluate the implementation of a multimodal HF management protocol (HFMP) administered in a SNF in 2021. Over 90% of eligible patients were enrolled in the HFMP (REACH). Of the 42 enrolled patients (61.9% female, aged 81.9 ± 8.9 years, 9.5% Medicaid), 2 (4.8%) were readmitted within 30 days of hospital discharge and 4 (9.5%) were readmitted within 30 days of SNF discharge compared with historical (2020) rates of 16.7% and 22.2%, respectively (a potential savings of $132,418-$176,573 in hospital costs) (EFFECTIVENESS). Although stakeholder feedback about ADOPTION and IMPLEMENTATION was largely positive, challenges associated with clinical data collection, documentation, and staff turnover were described. Findings will inform refinement of the HFMP to facilitate further testing and sustainability (MAINTENANCE).

Remote dielectric sensing to detect acute heart failure in patients with dyspnoea: a prospective observational study in the emergency department.

Aims: Remote dielectric sensing (ReDS) enables quick estimation of lung fluid content. To examine if ReDS is superior to other methods in detecting acute heart failure. Methods and results: We included consecutive patients with dyspnoea from the emergency departments at Bispebjerg Hospital, Copenhagen, and performed ReDS, low-dose chest computed tomography (CT), echocardiogram, lung ultrasound, NT-Pro-brain natriuretic peptide (NT-proBNP), and a Boston score evaluation (chest X-ray and clinical signs). ReDS values >35% were used as a cut-off to diagnose pulmonary congestion. Acute heart failure was adjudicated by experts' review of health records but independently of ReDS values. Sub-analyses investigated ReDS in acute heart failure patients with congestion on CT. We included 97 patients within a median of 4.8 h from admittance: 25 patients (26%) were ReDS-positive and 39 (40%) had adjudicated acute heart failure (21 with and 18 without CT congestion). Heart failure patients had median ReDS 33%, left ventricular ejection fraction 48%, and NT-proBNP 2935 ng/L. A positive ReDS detected heart failure with 46% sensitivity, 88% specificity, and 71% accuracy. The AUC for ReDS was like the Boston score (P = 0.88) and the lung ultrasound score (P = 0.74). CT-congested heart failure patients had higher ReDS values than patients without heart failure (median 38 vs. 28%, P < 0.001). Heart failure patients without CT-congestion had ReDS values like patients without heart failure (mean 30 vs. 28%, P = 0.07). Conclusion: ReDS detects acute heart failure similarly to the Boston score and lung ultrasound score, and ReDS primarily identifies the acute heart failure patients who have congestion on a chest CT.

A novel therapeutic strategy: remote dielectric sensing-guided management of pulmonary congestion.

Management of pulmonary congestion is a key to improve mortality and morbidity in patients with congestive heart failure, but it is often challenging due to a lack of gold standard to accurately assess the lung fluid level. We had an 86-year-old man who was admitted to our institute due to worsening congestive heart failure. His pulmonary congestion was quantified repeatedly by the novel noninvasive device, remote dielectric sensing, and was optimally managed by the medication adjustment. Remote dielectric sensing might be a promising device to quantify pulmonary congestion and guide clinicians to optimize medications in addition to the conventional multi-modalities. .

Early use of remote dielectric sensing after hospitalization to reduce heart failure readmissions.

AIMS: Readmission after hospitalization for acute decompensated heart failure (HF) remains a major public health problem. Use of remote dielectric sensing (ReDS) to measure lung water volume allows for an objective assessment of volume status and may guide medical optimization for HF. We hypothesized that the use of ReDS would lower 30 day readmission in patients referred to rapid follow-up (RFU) clinic after HF discharge. METHODS AND RESULTS: We conducted a retrospective analysis of the use of ReDS for patients scheduled for RFU within 10 days post-discharge for HF at Mount Sinai Hospital between 1 July 2017 and 31 July 2018. Diuretics were adjusted using a pre-specified algorithm. The association between use of ReDS and 30 day readmission was evaluated. A total of 220 patients were included. Mean age was 62.9 ± 14.7 years, and 36.4% were female. ReDS was performed in 80 (36.4%) and led to medication adjustment in 52 (65%). Use of ReDS was associated with a lower rate of 30 day cardiovascular readmission [2.6% vs. 11.8%, hazard ratio (HR): 0.21; 95% confidence interval (CI): 0.05-0.89; P = 0.04] and a trend towards lower all-cause readmission (6.5% vs. 14.1%, HR: 0.43; 95% CI: 0.16-1.15; P = 0.09) as compared with patients without a ReDS assessment. CONCLUSIONS: ReDS-guided HF therapy during RFU after HF hospitalization may be associated with lower risk of 30 day readmission.

Efficacy of remote dielectric sensing (ReDS) in the prevention of heart failure rehospitalizations: a meta-analysis.

The clinical efficacy of remote dielectric sensing (ReDS) monitoring is not well known. Digital databases were searched to identify relevant articles. Pooled unadjusted odds ratio (OR) for dichotomous outcomes were calculated using a random-effects model. Findings were reported as a point estimate with its 95% confidence interval (CI). A total of 985 patients across seven studies were included in the meta-analysis. Patients with heart failure monitored with ReDS had significantly lower odds of hospital readmission compared with non-ReDS patients (OR = 0.40; 95% CI 0.29-0.56; z = 5.43 p = 0.000, I2 = 0%). Subgroup analysis based on the duration of follow-up showed a lower odd of readmission within 30 days (OR = 0.36; 95% CI 0.18-0.71; z = 2.93; p = 0.003; I2 5.7%), as well as between 1 and 3 months (OR = 0.42; 95% CI 0.29-0.61; z = 4.54; p = 0.000; I2 = 0.0%). ReDS effect of lower readmissions of HF was observed irrespective of the duration of follow-up (<1-month vs 1-3 months). ReDS monitoring significantly lowers the odds of HF readmission within 3 months compared to participants not using ReDS.

Validation of Remote Dielectric Sensing (ReDS) in Monitoring Adult Patients Affected by COVID-19 Pneumonia.

Remote dielectric sensing (ReDS) is a non-invasive electromagnetic wave technology which provides an accurate reading of lung fluid content, and it has been reported as a valid tool in monitoring heart failure patients. Considering that morphological alterations in COVID-19 include pulmonary edema, the purpose of the present study was to evaluate the reliability of ReDS technology in assessing the excess of lung fluid status in COVID-19 pneumonia, as compared to CT scans. In this pilot single center study, confirmed COVID-19 patients were enrolled on admission to an intermediate care unit. Measurements with the ReDS system and CT scans were performed on admission and at weeks 1 and 2. Eleven patients were recruited. The average change in ReDS was -3.1 ± 1.7 after one week (p = 0.001) and -4.6 ± 2.9 after two weeks (p = 0.006). A similar trend was seen in total CT score (-3.3 ± 2.1, p = 0.001). The level of agreement between ReDS and CT changes yielded a perfect result. Statistically significant changes were observed in lactate dehydrogenase, lymphocytes, and c-reactive protein over 2 weeks. This pilot study shows that ReDS can track changes in lung involvement according to the severity of COVID-19. Further studies to detect early clinical deterioration are needed.

The use of the reds noninvasive lung fluid monitoring system to assess readiness for discharge in patients hospitalized with acute heart failure: A pilot study.

BACKGROUND: Inadequate decongestion is common in hospitalized heart failure (HF) patients and may contribute to readmissions. Our purpose was to use remote dielectric sensing (ReDS) technology to measure lung congestion at discharge in patients admitted with acute HF and to see if a device-targeted intervention could reduce HF readmission rates. METHODS: We conducted a prospective pilot study of patients admitted with acute decompensated HF randomized to receive standard therapy or ReDS-guided therapy to determine the timing of hospital discharge based on the amount of lung congestion present after diuresis. ReDS measurement was performed for all patients once they were deemed ready for discharge. Patients in the treatment arm with residual lung congestion defined by ReDS ≥39% had HF consultation and further diuresis. RESULTS: Of 108 HF patients (50% male, age 73.6 ±â€¯12.6 years, BMI 29.3 ±â€¯4.3 kg/m2, EF 38.5 ±â€¯15.1%, BNP 1138 ±â€¯987 pg/mL), 32% demonstrated residual lung congestion at the time of proposed hospital discharge. ReDS guided therapy triggered additional diuresis in 30% (18/60) of the patients in the treatment arm (average weight loss 5.6 pounds, p = 0.02). 30-day HF readmission rates were similar in the treatment and the control arms (1.7% vs 4.2%; p = 0.44). Patients discharged as planned with residual lung congestion with ReDS ≥39% had higher 30-day readmission rate compared to patients who were adequately decongested at discharge with ReDS <39% (11.8% vs. 1.4%, p = 0.03). CONCLUSION: In our single-center cohort, ReDS testing demonstrated that 32% of HF patients deemed ready for discharge have clinically significant residual lung congestion which was associated with a higher risk of readmission. ReDS-guided management was associated with significant decongestion but not a reduction in HF readmissions in this sample.