Scale That Measures Fluid Retention Improves Prediction of Heart Failure Events

DCRI News from Technology and Heart Failure Therapeutics 2024

MARCH 20, 2024 — A new approach to remote monitoring of heart failure patients could allow patients and providers to better predict and prevent impending heart failure events, according to results from the DCRI’s SCALE-HF 1 study.

Using data from the FDA-cleared Bodyport Cardiac Scale — which looks and functions similarly to an average bathroom scale, but also measures fluid accumulation in addition to weight — researchers evaluated a new index intended to predict heart failure events that required unplanned administration of IV diuretics, or hospital admissions with a primary diagnosis of heart failure.

Results from the multicenter observational study were presented by co-principal investigator and DCRI advanced heart failure cardiologist Marat Fudim, MD, MHS, as part of a late-breaking session at the Technology and Heart Failure Therapeutics 2024 conference on March 6. They showed that evaluating patient fluid retention could detect twice as many heart failure events as the current standard-of-care approach.

Marat Fudim

“To date, the gold standard is to measure your weight, and if your weight goes up, let your doctor know, and take more diuretics,” Fudim said.

However, that standard weight rule — which takes effect when a patient gains 3 lbs. in one day or 5 lbs. in a week — is often not sufficient to predict and potentially prevent an impending heart failure event.

“In clinical practice, when a patient calls with a weight gain of 3 lbs. or more, the process of decompensation can often no longer be prevented,” Fudim said. “In reality, patients also often call too late when the weight gain is even more substantial given that communication back and forth with clinical practices are often not straight forward either.”

In the retrospective study, researchers applied the new algorithm to look at data from 329 heart failure patients who had taken their own measurements by stepping on the scale for about 20 seconds each day. The index highlighted instances in which the scale detected increased fluid retention, and the congestion scale proved to be a better predictor of heart failure events than the standard weight rule.

Of the 69 heart failure events that occurred, the congestion alert detected 70 percent of heart failure events, whereas the standard weight rule predicted only 35 percent.

Future studies are in development to assess the validity of additional data provided by the same scale to potentially provide even more precise predictions for heart failure events.

“This was a validation of an existing score, but because we have a broader range of sensors built in the scale, we have the opportunity to test an even more complex score in the future,” Fudim said. “There will be a SCALE-HF 2 coming out at some point in the future that may validate the complex score.”

The Bodyport Cardiac Scale also includes sensors to indicate stroke volume — how much blood the heart pumps out per contraction — as well as heart rate and respiratory rate. These capabilities have not yet been approved by the FDA and were not included in this trial.

More from DCRI Cardiologists at THT

• A pilot study on an implant device showed favorable changes in heart failure patient symptoms and echo parameters, according to results from the RECOVER-HF pilot study presented by Fudim in another THT late-breaking session on March 5.

The VisONE Implant System, placed through a minimally invasive procedure, stimulates the diaphragm to help the heart expand and relax as it should.

“How is it possible that this little deflection can be helpful? I think the solution here is that every beat results in a small stroke volume increase by about 10%,” Fudim said. “If every time you get 10% extra help, well, that’s 10% less the heart has to work, and gets to relax. That may explain why the function improves at the -month mark and why the heart shrinks.”

Christopher Granger, MD, addressed how to engage the right stakeholders to navigate the barriers and facilitators of implementation to improve heart failure practice. 

Mitchell Krucoff, MD, shared technology updates in cardiogenic shock, and what to know about percutaneous pumps for Shock and Percutaneous Coronary Intervention.

Robert Mentz, MD, shared insights on transplantation versus left ventricular assist devices for heart failure, and whether implantable cardioverter-defibrillators should be used for primary prevention in patients with non-ischemic dilated cardiomyopathy.