Thuis-bio-impedantie voor hartfalen: haalbaar en acceptabel, klinische winst (nog) niet aangetoond

INTRODUCTION: This study evaluated the feasibility, acceptability, and clinical effectiveness of a home-based body water monitoring and pre-emptive management system using bioelectrical impedance analysis (BIA) in patients with heart failure (HF). METHODS: In this multicentre, open-label, randomized controlled trial, 40 HF patients receiving loop diuretics were assigned to standard care or a home BIA group using a home-based BIA device with a linked application providing weekly feedback and guidance on diuretic management. Feasibility outcomes included study completion, adherence, usability and acceptability scores, and adverse events over 12 weeks. Effectiveness outcomes included changes in NT-proBNP, oedema index, New York Heart Association (NYHA) functional class, HF hospitalization, and all-cause mortality. RESULTS: Thirty-nine patients were included in the final analysis after exclusion of one patient lost to follow-up in the control group. Patients in the control group were older than those in the home BIA group (70.4 ± 8.3 vs 57.2 ± 13.5; P = .003), and baseline NT-proBNP levels were higher (2737.1 ± 3817.1 vs 1357.7 ± 2196.8 pg/ml; P = .013), while other baseline characteristics were comparable. In the home BIA group, the completion rate was 100.0% and adherence to BIA measurements was 82.5%. Acute kidney injury occurred in one patient (5.0%), with no discontinuations due to adverse events. Usability and acceptability were high (4.21 ± 0.59; 3.90 ± 0.53, respectively) on a 5-point Likert scale. There were no significant differences in changes in NT-proBNP or oedema index during follow-up between groups. Worsening NYHA class occurred less frequently in the home BIA group (10.0% vs 31.6%; P = .095). Changes in the oedema index correlated with changes in NT-proBNP (r = 0.544; P = .002), whereas changes in body weight did not (r = 0.237; P = .147). No HF hospitalizations or deaths occurred. CONCLUSION: Home-based BIA monitoring with pre-emptive management is feasible, acceptable, and safe for patients with HF.