Current approaches to monitoring and management of heart failure

Decompensation in patients with congestive heart failure remains a treatment problem. Earlier detection of decompensation may result in a lessened need for hospitalization and perhaps an interruption of the as-yet-undetermined processes during decompensation that lead to an adverse effect on the natural history of heart failure. B-type natriuretic peptide is produced by right and/or left ventricular tissue in response to an increase in ventricular wall stress and may be used as an indicator of decompensation. New directions in monitoring now include novel device-based algorithms that determine either intraventricular pressure or intrathoracic impedance. When combined with clinical assessment, weight monitoring, and symptom assessment, these newer monitoring platforms may yield improvements in the natural history of heart failure.