The Evaluation and Monitoring of Volume Status in Congestive Heart Failure

The increasing prevalence of heart failure dictates that physicians effectively assess and treat congestion. The evaluation of volume status in the complex group of patients with heart failure is very challenging. Physical examination is at best challenging and not always helpful, confounded by body habitus and comorbidities. Weight monitoring has been shown to be helpful, especially in combination with remote monitoring or telephonic checks. Invasive methods such as pulmonary artery catheters provide significant information but have not been proven to be clinically effective. Noninvasive measures such as impedance cardiography and echocardiography provide additional information. The future of heart failure management may reside in implantable monitors, either alone or in combination with other intracardiac devices. These monitors can provide surrogates of pulmonary capillary wedge pressure and volume. They can also be followed remotely and provide information on the patient's status more frequently than office visits. This manuscript will review volume assessment including past, current, and future methods.