Effect of Impedance-Guided Fluid Therapy on Treatment Outcomes of Patients with Heart Failure: A Systematic Review and Meta-Analysis.

INTRODUCTION Traditional volumetric assessment methods have limitations in the management of HF. The clinical value of impedance-guided monitoring (including bioelectrical impedance analysis [BIA], lung/thoracic impedance [LI], or intrathoracic impedance monitoring [IIM]) for quantifying extracellular fluid status remains controversial. This study aims to systematically evaluate the effect of impedance-guided fluid management on rehospitalization rates, mortality, and other outcomes in patients with HF.

Methods

PubMed, Embase, and Web of Science were searched from inception to May 31, 2025, for randomized controlled trials (RCTs) comparing impedance-guided fluid therapy with standard care in patients with HF. This review was conducted in accordance with the PRISMA guidelines.

Results

A total of 4 RCTs or secondary analyses of RCTs involving 650 patients with HF (impedance- guided group: 326 cases) were included. The risk of rehospitalization for HF was reduced without statistical significance in the impedance-guided group (OR: 0.73, 95% CI: 0.22- 2.48), while the risk of mortality for HF demonstrated a statistically significant reduction (OR: 0.33, 95% CI: 0.20-0.56), though these findings should be interpreted with caution given the limited number of included studies. The impedance-guided group demonstrated positive trends in reducing the incidence of acute kidney injury (AKI), lowering N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and improving quality of life. These outcomes were not subjected to analysis due to data heterogeneity.

Discussion

This meta-analysis suggests that impedance-guided fluid management did not demonstrate a statistically significant reduction in HF rehospitalization in the pooled analysis, though a consistent directional trend was observed. However, the statistics about HF-related mortality among patients with HF showed that impedance-guided fluid therapy potentially provided a tool for more precise volume management. Also, these findings are based on a limited number of studies with methodological heterogeneity.

Conclusion

Impedance-guided fluid management may represent a potential adjunct for reducing rehospitalization in patients with HF. Given the methodological heterogeneity and small number of included studies in this research, future large-scale, high-quality RCTs are needed to confirm these results in clinical practice.