Identifying patients’ signs and symptoms to guide eHealth-directed diuretic therapy intensification in heart failure—Insights from the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF)

Heart failure significantly burdens healthcare systems. eHealth products could alleviate this burden by providing patients with recommendations for intensifying diuretic therapy. As evidence on guiding diuretic therapy is scarce, our goal was to identify clinical parameters that eHealth products can use to support heart failure patients in intensifying their diuretic therapy. A post-hoc analysis of the trial of intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF), comparing an NT-proBNP-guided management strategy with a symptom-guided strategy in elderly heart failure patients, was conducted. Clinical data were collected during patient evaluations at 1, 3, 6, and 12 months of follow-up. At each visit, any increase or new prescription of diuretic therapy was recorded as the outcome event. Mixed-effects logistic regression analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI), investigating the relationship between the patient data and the odds of diuretic therapy intensification. In this retrospective analysis, 568 heart failure patients were included. Over a 12-month period, 2013 follow-up visits were conducted, during which diuretics were initiated or increased in 370 visits (18.4%). Higher New York Heart Association (NYHA) classification (OR 2.60, 95%CI 1.94-3.50), presence of edema (OR 2.84, 95%CI 2.15-3.77), paroxysmal nocturnal dyspnea (OR 1.52, 95%CI 1.04-2.21), and orthopnea (OR 1.39, 95%CI 1.04-1.85) were significantly associated with the initiation or increase of diuretics. Dyspnea, edema, paroxysmal nocturnal dyspnea, and orthopnea are associated with the intensification of diuretic treatment in HF patients. These symptoms, which patients can easily report, should be integrated into eHealth devices that offer guidance on managing diuretic therapy.