Current Standard of Care For Recognizing Fluid Volume Overload
One of the most challenging aspects of heart failure management is regulating intravascular fluid volume because the tools currently in use are insensitive even to life-threatening changes in intravascular volume.
Fluid volume overload causes progressive increases in LVEDP (left ventricular end-diastolic pressure, the most reliable indicator of the presence and severity of heart failure) which, in turn, causes pulmonary congestion, shortness of breath, declining quality of life and frequent hospitalizations.
Clinicians rely on clinical assessment (history and physical findings) to maintain optimal volume and adjust medications but physical findings are often absent in chronic heart failure even when LVEDP levels are high. There is now evidence that many patients have abnormally elevated LVEDP levels pressures long before the onset of symptoms or physical findings. As a result, these patients may go untreated until hospitalization or death supervenes.
“Gold Standard” for Evaluating Fluid Overload Is Invasive & Potentially Dangerous
The "gold standard" for heart failure management for more than 50 years has been pulmonary artery catheterization in hospital ICUs. By positioning the pulmonary artery catheter in a pulmonary vessel, the pressure of blood entering the heart from the lungs can be measured. This pressure estimates LVEDP with a clinically useful level of accuracy. While this approach to managing LVEDP remained the "gold standard" for monitoring of heart failure patients for decades, its use has greatly diminished because of its invasiveness and potential for complications.
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