Integrating Lung Ultrasound and the HEFESTOS Score in the Outpatient Heart Failure Management: A Prospective Cohort Study

Heart failure (HF) is a major cause of morbidity, mortality, and healthcare costs, especially in older adults. Effective outpatient risk stratification remains a key challenge, particularly after hospital discharge or acute decompensation. Lung ultrasound (LUS) and the HEFESTOS score have individually shown prognostic utility, but their combined use has not been extensively studied in primary care. This prospective cohort study included 107 patients with confirmed HF followed in a primary care center in southern Catalonia. At baseline, all patients underwent LUS and HEFESTOS assessment. The primary outcome was HF decompensation, defined as worsening symptoms requiring medical attention, emergency care, hospitalization, or death. Over a mean follow-up period of 72 days, 26 patients (24.3%) experienced decompensation. In multivariate analysis, only the HEFESTOS score was significantly associated with this outcome. LUS and HEFESTOS showed moderate agreement (Kappa = 0.456), and LUS demonstrated good discriminative capacity (AUC = 0.808), with high sensitivity (81.7%) and positive predictive value (81.7%). These findings suggest that while the HEFESTOS score remains a strong independent predictor of decompensation, LUS may provide complementary value in early detection of pulmonary congestion. Their combined application in primary care settings could improve risk stratification and potentially guide follow-up strategies for patients with HF.