Enhancing Sweat Rate for In-Hospital and Home-Based Decongestive Therapy.

Abstract

Background: The interstitial fluid compartment is disproportionally expanded in heart failure (HF). Enhancing sweat rate remove fluids and sodium directly from the interstitial compartment.

Objectives: To study the feasibility and efficacy of direct interstitial decongestion in hospitalized HF patients.

Methods: We used a device designed to enhance fluid and salt expulsion via the eccrine sweat glands. Patients were treated for 1-6 days in the hospital. Following discharge, home therapy continued for 30-60 days (1-4 treatments/week). The primary efficacy endpoint for the in-hospital phase was a fluid loss of ≥500 mL per ≥4h per treatment. Secondary performance endpoints included changes in congestion score and NT-pro-BNP levels, evaluated for each phase separately.

Results: We studied 15 patients, 12 completing both the hospital and home phases. During the in-hospital and home phases, median weight change due to device therapy was 2.4 Kg [IQR 2.20-3.77], and the primary endpoint was met in 86% of treatment sessions. During the home treatment, median weight loss was 3.1 Kg [IQR 0.6 to 7.4 Kg]. Congestion score declined from 6 [IQR 6-7] to 1 [IQR 1-1.5] at the end of home therapy (P=0.002). Median NT-proBNP levels decreased from 7732 [IQR 4694-9746] to 4984 pg/mL [IQR 3559-8950](P=0.01) during the hospital phase and to 3596 ng/mL [IQR 1640-5742](P=0.02) at the end of home therapy.

Conclusion: Fluid removal via the skin is useful in enhancing decongestion in hospitalized ADHF patients. Following hospital discharge, device therapy was associated with additional improvement in decongestion.