Abstract 19079: Assessment of Heart Sounds, Physiologic Changes, and Sleep Performance Using Non-Invasive Monitoring in a Volume Depleted Heart Failure Patient

Case: A 46-year-old male with EF 15% who was co-enrolled in two non-invasive remote monitoring clinical trials, using the WHOOP strap and Nanowear vest to track heart failure (HF) progression at Hershey Medical Center was readmitted for volume depletion. Our patient presented to his PCP’s office complaining of daytime fatigue. Review of systems was negative including no dizziness or light headedness. Blood pressures during this visit was 85/50 and 79/49. He was sent to the emergency department where he had persistent hypotension with a creatinine elevation from 2.4 to 3.71. He was admitted for IV fluid resuscitation and diuretic optimization.

Methods: We report cumulative metrics pre- and post-hospitalization showing significant changes in sleep performance and S3 heart sound magnitude. Other measured variables with WHOOP included heart rate (HR), respiratory rate (RR), rapid eye movement (REM) sleep, and heart rate variability (HRV).

Results: Following adequate hydration, return to euvolemia, and diuretic adjustment, the patient had statistically significant improvement in sleep metrics (Figure 1, Graph C). Patient’s daily strain, a surrogate of HR elevation over time, was also significantly decreased post discharge (5.19 to 0.73, p <0.01). Patient’s S3 heart sounds were measured during both hospitalizations and showed a decrease in amplitude consistent with volume depletion (Figure 1, Graphs A/B).

Conclusion: We report physiologic trends that correlate with clinical status as measured using two novel non-invasive monitoring strategies. Poor sleep secondary to orthopnea and paroxysmal nocturnal dyspnea are considered signs that indicate volume overload. This case, indicates that volume depletion in patients with severely reduced EFs could also contribute to poor sleep performance, indicating a narrow therapeutic window. Further studies may validate these devices as remote monitoring tools for HF management.