Patients with heart failure (HF) should weigh themselves daily, as weight gain can indicate that the body is retaining fluid and weight loss can indicate cachexia, which is characterized by the loss of healthy muscle mass.1 According to the 2013 American Heart Association Guidelines for HF management, worsening HF is often characterized by episodes of fluid retention, and weight loss may be a sign of clinical deterioration as well.2 Weight changes of any kind in someone with HF are clinically important and should be closely followed.
Weight Gain
Rapid weight gain is important to monitor because it often indicates edema (fluid retention) in someone with HF.3,4 Edema may be seen as swelling in the legs, ankles, and sacral region. Adults with HF should be counseled by medical professionals on how to measure their weight properly and determine when there is cause for concern. They should weigh themselves each morning at the same time, after urinating, and before consuming food or beverage. They should also wear the same amount of clothing each time they weigh themselves. Typically weight gain of two to three pounds in a day or five pounds in a week should result in a call to their doctor.5 In addition to this, using a logbook to record daily weight is important. A study by Park et al. found that HF patients who recorded their daily weight had greater survival after three months compared to those who did not record their weight daily.6
Weight gain has been found to be associated with a greater risk of hospitalization among adults with HF.7 In a nested case-control study of 134 patients hospitalized for HF (matched to patients without HF hospitalizations), in the 30 days prior to the hospitalization, weight gain over a 7-day period was associated with higher odds of hospitalization.8 This association had a graded pattern where weight gain between two and five pounds was associated with 2.77 higher odds of hospitalization (95% confidence interval [CI] [1.13 – 6.80]), weight gain between five to ten pounds was associated with 4.46 higher odds of hospitalization (95% CI [1.45 – 13.75]) and weight gain of more than ten pounds was associated with a 7.65 higher odds of hospitalization (95% CI [2.22 – 26.39]). The results of this study indicate that greater weight gain among adults with HF may be a sign of adverse outcomes, such as worsening disease that requires hospitalization.
Monitoring weight at home was associated with improved outcomes in HF. 7 In a meta-analysis of 6,258 patients and 2,354 patients included in randomized controlled trials (RCTs) and cohort studies respectively, Klersy et al. found that closely monitoring weight at home is associated with protective clinical effects in HF. Specifically, these studies found that monitoring weight was significantly associated with lower risk of mortality (RCTs: relative risk [RR] 0.83, 95% confidence interval [CI] [0.73 – 0.95], p<0.006; cohort studies: RR 0.53, 95% CI [0.29 – 0.96], p<0.001) and hospitalizations (RCTs: RR 0.93, 95% CI [0.87 – 0.99], p<0.030; cohort studies: RR 0.52, 95% CI [0.28 – 0.96], p<0.001). Given these findings, adults with HF should frequently monitor their weight at home to reduce their risk of mortality and hospitalization.
Weight Loss
Weight loss over a short period of time can also signal a change in the clinical status of adults with HF. Cardiac cachexia, or wasting syndrome, is characterized by weight loss of 6% or more of body weight and is detrimental to almost all organ systems.9 The muscle wasting that occurs in cachectic patients is likely due to hormone imbalances that cause a change in appetite and nutrient intake. Also, changes in protein synthesis and degradation due to left ventricular dysfunction can lead to cachexia.10 Cachexia can cause impairments to respiratory function, reduce bone and muscle mass, and reduce immunity in patients, making them prone to infection.9 Studies have shown that cachexia is correlated with poor prognosis and high rates of mortality in HF patients.11 This association is independent of age, disease severity, exercise capacity, and left ventricular ejection fraction.12 Additionally, an observational study of 1,929 adults with HF found that weight loss of 6% or more at any time during the mean 35-month follow-up period was independently associated with decreased survival.13
References
- Rahman A, Jafry S, Jeejeebhoy K, et al. Malnutrition and cachexia in heart failure. JPEN J Parenter Enteral Nutr 2016; 40 (4): 475-486.
- Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62 (16): e147-239.
- Clark AL, Cleland JG. Causes and treatment of oedema in patients with heart failure. Nat Rev Cardiol 2013; 10 (3): 156-170.
- Lent-Schochet D, Jialal I. Physiology, Edema. In: StatPearls. Treasure Island (FL)2020.
- Washburn SC, Hornberger CA. Nurse educator guidelines for the management of heart failure. J Contin Educ Nurs 2008; 39 (6): 263-267.
- Park LG, Dracup K, Whooley MA, et al. Symptom diary use and improved survival for patients with heart failure. Circ Heart Fail 2017; 10 (11).
- Klersy C, De Silvestri A, Gabutti G, et al. A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol 2009; 54 (18): 1683-1694.
- Chaudhry SI, Wang Y, Concato J, et al. Patterns of weight change preceding hospitalization for heart failure. Circulation 2007; 116 (14): 1549-1554.
- Okoshi MP, Romeiro FG, Paiva SA, et al. Heart failure-induced cachexia. Arq Bras Cardiol 2013; 100 (5): 476-482.
- von Haehling S, Ebner N, Dos Santos MR, et al. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol 2017; 14 (6): 323-341.
- Anker SD, Ponikowski P, Varney S, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997; 349 (9058): 1050-1053.
- Anker SD, Sharma R. The syndrome of cardiac cachexia. Int J Cardiol 2002; 85 (1): 51-66.
- Anker SD, Negassa A, Coats AJ, et al. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet 2003; 361 (9363): 1077-1083.
