Acute heat wave episodes linked to potentially dangerous weight loss in HF
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Excessively high temperatures observed during a 2019 heat wave in France were closely associated with weight loss measured in adults with chronic HF, indicating worsening of HF, according to an analysis of telemonitoring and weather data.
France was one of the countries most affected by the heat wave of 2019, with much of the country exceeding 90°F on June 26, François Roubille, MD, PhD, head of the intensive care unit, cardiology, at the University Hospital of Montpellier, France, and colleagues wrote in ESC Heart Failure. Despite proactive measures by the French government, such as opening public cooling rooms and providing extended hours for parks and public pools, patients with HF presented strong variations in weight that seem clinically relevant, they wrote.
“This study is the first to show a strict relationship between ambient temperature and body weight in heart failure patients,” Roubille said in a press release. “The finding is timely given the heat waves again this year. The weight loss we observed in people with heart failure may lead to low blood pressure, especially when standing up, and renal failure, and is potentially life-threatening. With rising temperatures forecast for the future, clinicians and patients should be ready to reduce the dose of diuretics when weight loss occurs.”
Assessing temperature, body weight data
Roubille and colleagues analyzed data from 1,420 adults with chronic HF hospitalized for acute HF in the previous month, followed via a telemonitoring system managed by CDM e-Health from June to September 2019 to accurately catch the two heat waves that occurred in France at the end of June and July. The median age of patients was 73 years; mean weight was 78.1 kg and 28% were women. Patients were from 68 counties, representing 71% of French territory. Weights were obtained during routine practice; some patients provided daily measurements as requested. Patients reported daily symptoms such as edema, fatigue, breathlessness and cough by answering questions on a personal device, with answers sent automatically to the clinic. Researchers used the closest weather station from the residence of each patient to obtain daily temperatures. The researchers analyzed the association between patient weight, ambient temperature on the same day and temperature 2 days before the weight measurement.
“All patients were followed in the same manner, including daily weight monitoring using online scales, self-monitoring and symptom reporting via a device,” the researchers wrote. “Weight remains the cornerstone of telemonitoring in patients with HF, because it is related to congestion.”
Researchers found the relationship between temperature and weight was “very strong” (P < 10-7), and there was a strong relationship between patient weight and the probability of a cardiac alert (from clinical evaluation, P < 10-16). Patient sex was not associated with the occurrence of alerts; however, age was, as older patients presented with more alerts, according to researchers.
“In contrast, no direct significant relationship was found between temperature and the occurrence of an alert, which suggests a different impact of temperature increase on weight variations leading to alerts and a mediation effect between cardiac alerts and temperature via weight,” the researchers wrote.
Adjusting diuretic medication
Daily temperature 2 days before weight measurement was related to alerts (P = .002); there was no clear threshold between temperature and weight.
“Given the expectation of more heat waves, telemonitoring systems also need to alert clinicians of weight loss in heart failure patients,” Roubille said in the release. “In addition, systems could notify patients losing weight that it may be due to the heat, and they should contact their health care provider about reducing the dose of diuretics. For heart failure patients not monitored remotely, a good rule of thumb would be to contact a health care professional if weight drops by 2 kg during a heat wave for advice on adjusting diuretic medication. Reacting early should help us to prevent complications.”
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