Compression wraps as adjuvant therapy in the management of acute systolic heart failure: A pilot clinical trial

Document Type

Conference Proceeding

Publication Date

10-14-2021

Publication Title

Eur Heart J

Abstract

Background/Introduction: Current guidelines recommend targeting overall decongestion in management of patients with decompensated heart failure. With lower extremity edema among the most prevalent symptoms in patients admitted with decompensation, this often serves as a clinical target. Lower extremity compression wraps (LECW) are seldom used in the acute setting, with little data on efficacy in heart failure, despite serving as a cornerstone of chronic lymphedema management. Purpose: Evaluate the efficacy of LECW as adjuvant therapy in management of HF with reduced ejection fraction (EF). Methods: Open-label, randomized, parallel group controlled trial, with 2:1 randomization of adult patients with a history of HF and reduced EF less than 40% admitted to telemetry unit for intravenous (IV) diuretic therapy. Results: A total of 32 patients were enrolled, with 29 patients completing the study; 19 (66%) in the control arm, and 10 (34%) in the intervention arm. There were no significant differences in baseline characteristics of the two groups. Patients in the intervention arm required less escalation of diuretic therapy (0 vs 5 patients, p=0.079), and less frequent use of continuous infusion therapy (0 vs 7 patients, p=0.027). Total days of IV diuresis was not significantly different between the two groups. Greater net reduction of edema was seen in the intervention group (1.5+ [1-2] vs 1+ [1-2], p=0.072), with fewer cases of acute kidney injury (1 vs 13, p=0.005). The intervention group scored significantly better on MLWHF (55.5 vs 65, p=0.021), including both the physical (17.5 vs 23, p<0.001) and emotional (5.5 vs 11, p<0.001) dimension scores. Overall LOS was shorter in the intervention group (3.5 [3-7] vs 6 [5-10] days, p=0.05). A Poisson regression model was used to examine the effect of intervention on LOS (IRR=0.62, 95% CI 0.44-0.86, p=0.005), suggesting an overall 38% shorter LOS. Conclusion: In this open-label parallel group RCT, use of LECW resulted in less IV diuretic continuous infusion therapy, greater net reduction in lower extremity edema, reduced patient assessed HF burden, and shorter hospital LOS, with fewer rates of AKI. Trends toward fewer total days of IV diuresis, less escalation of diuresis, and greater reduction in edema were also observed. Larger scale clinical trials are needed to further establish LECW as efficacious adjuvant therapy in the management of acute heart failure.

Volume

42

First Page

1055

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