In this episode of Beatwise The Podcast, I speak with Dr Archana Ganapathy about a problem we don’t talk about enough in heart failure: congestion that we can’t properly see.

Many patients leave hospital still fluid overloaded at a tissue level - despite looking “better” clinically. And that gap is part of why readmissions and outcomes remain poor. We discuss why current tools - from clinical exam to imaging and biomarkers - often fall short, and why understanding where fluid sits in the body matters just as much as how much is there.

We then explore bioimpedance: what it is, how it works at the bedside, and why it may offer a more objective way to guide treatment. Dr Ganapathy also shares early insights from the BioHF trial, including what happens when fluid management is guided by measurement rather than estimation.

For further context, Dr Ganapathy’s recent review on congestion assessment in decompensated heart failure is linked here: Advances in Congestion Assessment in Decompensated Heart Failure

Key issues addressed: 

• Why “hidden” congestion is so common in heart failure
• The limitations of weight, BNP, imaging and clinical exam
• Why fluid distribution matters
• How bioimpedance works in practice
• Early findings from the BioHF trial

If you care for patients with heart failure - or live with it - this is worth understanding.

EPISODE HIGHLIGHTS:

00:00 Hidden congestion problem

02:00 Why assessment falls short

05:05 Fluid location matters

07:02 Promise of bioimpedance

08:54 How bioimpedance works

13:06 BioHF trial design

17:16 Early findings & future impact

22:29 Recruitment & next steps

23:06 Wrap up

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Thank you to Maltron International Limited for sponsoring this episode.

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