Key result
A pre-discharge B-lines score of ≥9 on lung ultrasound independently predicted a nearly five-fold increased risk of 60-day rehospitalization and total mortality (HR 4.865) in patients with acute heart failure.
Why the study?
Persistent hemodynamic congestion despite clinical improvement causes high post-discharge rehospitalization rates in acute heart failure, and the prognostic value of pre-discharge lung ultrasound B-lines and the EVEREST score warranted evaluation.
Do pre-discharge B-lines ≥9 and EVEREST score ≥2 predict rehospitalization and total mortality in patients with acute heart failure?
Cohort (n=66)
No
Do pre-discharge B-lines ≥9 and EVEREST score ≥2 predict rehospitalization and total mortality in patients with acute heart failure?
Hazard Ratio: 4.865 (95% CI 1.749–13.534)
p-value: p=0.002
Pre-discharge assessment of residual congestion using lung ultrasound B-lines and the clinical EVEREST score can independently predict short-term rehospitalization and mortality in patients with acute heart failure.
Background: The high rate of rehospitalization in the vulnerable phase after treatment for acute heart failure (AHF) is caused by persistent hemodynamic congestion, even though the patient has experienced clinical improvement before being discharged. The B-lines value on Lung Ultrasound is a hemodynamic parameter that has the potential to determine the post-treatment prognosis of patients with AHF, while the EVEREST score is a marker of congestion which consists of several parameters used to assess congestion clinically. Methods: Patients treated for AHF with varying ejection fraction (EF) were included in this prospective cohort study. Data on demographics, comorbidities, pre-discharge therapy and pre-discharge echocardiographic parameters were collected. The pre-discharge B-lines value and EVEREST score were calculated a maximum of 24 hours before the patient was discharged. The outcomes studied were rehospitalization and total mortality within 60 days. Results: A total of 66 samples with various EF were included until the end of the study (15 HFpEF, 8 HFmrEF, and 43 HFrEF, mean age 57.14 ± 14.68 years). During the 60-day follow-up period, 19 samples (28.9%) experienced rehospitalization and total mortality. Both the B-lines value (AUC 0.716; 95%CI 0.581-0.851; p<0.006) and the EVEREST score (AUC 0.675; 95%CI 0.542-0.807%; p<0.027) served as predictors of rehospitalization and total mortality. The regression model showed that the pre-discharge B-lines score was ≥9 (adjusted HR 4.865; 95%CI 1.749-13.534; p=0.002) and the pre-discharge EVEREST score ≥2 (adjusted HR 3.694; 95%CI 1.211-11.262; p=0.022) played an independent role as a predictor of rehospitalization and total mortality, regardless of BMI, diabetes mellitus, renal impairment or TAPSE. Conclusion: The pre-discharge B-line value and EVEREST score can be applied to stratify the risk of rehospitalization and total mortality after treatment for patients with AHF.
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Suadnyana et al. (2023) conducted a cohort in Acute Heart Failure (n=66). Pre-discharge B-lines score ≥9 vs. Pre-discharge B-lines score <9 was evaluated on Rehospitalization and total mortality within 60 days (HR 4.865, 95% CI 1.749-13.534, p=0.002). A pre-discharge B-lines score of ≥9 on lung ultrasound independently predicted a nearly five-fold increased risk of 60-day rehospitalization and total mortality (HR 4.865) in patients with acute heart failure.
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