Telemonitoring of fluid status in heart failure: CHAMPION

Ever since what is now called heart failure was first recognised as a disorder of excessive fluid accumulation, the holy grail of its management has been to accurately evaluate volume status in a timely and ongoing manner. Early detection of fluid accumulation (even before the patient notices a change in symptoms) permits institution of appropriate corrective drug therapies (eg, diuretics and vasodilators) to remove fluid, lower intracardiac pressures, or both, and thus minimise major cardiovascular events.1 For centuries, assessment of fluid status was confined to crude assessment of indicative clinical signs, later augmented by auscultatory evaluation of the heart and lungs, and chest radiography. Besides the use of weight change as a surrogate for short-term fluid shifts, there things stood until the second half of the last century when right-heart catheterisation was used to provide a more accurate assessment of pulmonary vasculature status and intracardiac pressures, albeit in the short term and not without risk.2 Telemonitoring of routine data (eg, weight, symptoms) has been explored but has yielded some disappointing results,[3] and [4] which suggests that more sophisticated, precise, and timely physiological information is needed to affect the condition meaningfully. Serial measurement of plasma concentrations of B-type natriuretic peptide (or larger precursor peptides), which reflect ventricular wall stress, might be of use to guide therapy and prolong survival.5 P Porapakkham, P Porapakkham, H Zimmet, B Billah and H Krum, B-type natriuretic peptide-guided heart failure therapy: a meta-analysis, Arch Intern Med 170 (2010), pp. 507a??514. View Record in Scopus Cited By in Scopus (20)5