Intrathoracic impedance falls as the amount of fluid in the lungs increases, due to fluid being a good conductor of electrical current, 7-9 raising the possibility that this technology may be clinically useful in providing an early warning of decompensation. Implantable Intrathoracic Impedance Monitoring Various, more sophisticated, methods of assessing heart failure control have been proposed, including serial measurement of B-type natriuretic peptide, 5 implantable haemodynamic monitors 6 and implantable intrathoracic impedance monitors. Such measures are far from perfect - in chronic heart failure many patients may not have marked clinical signs or symptoms, despite high and possibly rising pulmonary capillary wedge pressures. Physicians rely on the subjective assessment of exercise tolerance and breathlessness, changes in body weight and clinical examination to detect increasing dependent oedema or lung crackles. Unfortunately, the monitoring of heart failure syndrome control in clinical practice is usually relatively unsophisticated.
2 Recent efforts to reduce the risk of re-hospitalisation have largely focused on multidisciplinary disease management teams working with patients to ensure adherence to medication and the early detection of signs of decompensation, particularly in the early period after hospital discharge. In-hospital mortality was reported as 6.9% and by 12 weeks the mortality had risen to 13.5%, with a risk of re-hospitalisation of 24%. 2 Such admissions are usually long, with an average duration of 11 days. 1 A pan-European survey has shown that up to 65% of patients hospitalised with heart failure have a past history of chronic heart failure.
Management of heart failure consumes 1% to 2% of the healthcare budget in developed countries, with the largest share due to the cost of hospitalisations.
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