So the challenge of HF management remains the question that if daily weight measurements are not useful, what other strategies are available for monitoring HF patients?  Figure 16 illustrates how weights are a late marker and often, if present at all, do not help prevent decompensation in HF patients.^[11]  There are other parameters that can be assessed, such as intrathoracic impedance or heart rate variability, that due track much better with rises in filling pressures and that do predict risk for impending decompensation with greater efficiency.

The challenge with those measures is that they are not often as actionable as we might like.  It is difficult for clinicians to interpret a change in impedance or heart rate variability in a way that translates into effective medical therapy to prevent decompensation, and often therefore these data, when systemically studied in randomized trials, have not yielded the hoped-for incremental benefit with regard to outcomes.

What are we really trying to estimate with weights, changes in impedance, or heart rate variability changes?  The answer is changes in filling pressure, which until recently we have not had the ability to measure directly.