Key result
Pre-discharge lung ultrasound with ≥30 B-lines linked to ~4.7-fold higher readmission or mortality in AHF.
Why the study?
Persistent congestion is a major cause of rehospitalization in acute heart failure patients, and lung ultrasound is a valid tool to assess pulmonary congestion but its predictive value pre-discharge was unclear.
Cohort (n=127)
Double-blind
No
Hazard Ratio: 4.71 (95% CI 2.15–10.32)
p-value: p=<0.001
May inform discharge risk stratification in acute HF; hypothesis-generating and requires prospective trials before practice change.
Backgroud: Persistent congestion is a major cause of rehospitalization in patients with acute heart failure (AHF). Lung Ultrasound (LUS) is an easy and valid examination in assessing pulmonary congestion. The number of B-lines correlates very strongly with the amount of extravascular lung fluid (EVLW). The aim of this study is to determine if LUS pre-discharge can predict rehospitalization or mortality. Methods: This single centered cohort study included 127 consecutive AHF patients. LUS on 28 antorolateral chest wall segment was done double blindly before discharging the patient to calculate the B-line. Clinical data, Composite Congestion Score (CCS) and echocardiography were collected. Cox proportional hazard regression analysis was performed to assess the independent predictor of rehabilitation or mortality during 120 days of observation. Results: The patients were 57.4 ± 7.8 years old, most were male (66.9%), with LV EF 36.7 ± 7.2%. The etiology of heart failure was caused by coronary heart disease (56.7%) and hypertensive heart disease (40.9%). The median number of B-lines was 24 (15 - 39). Hospitalization or death occurred in 43 patients (33.8%) during the median observation of 120 days (73-120). Patients with B-line pre-discharge ≥30 had a lower mean survival (log rank X2 48.14; p <0.001). In multivariate analysis, B-line pre-discharge ≥30 was the strongest independent predictor of rehabilitation or mortality (HR 4.71; 95% CI 2.15 - 10.32). Other independent predictors are Composite Congestion Score (CCS) ≥ 3 (HR 4.26; 95% CI 2.07 - 8.77) and NYHA functional class III (HR 2.87; 95% CI 1.49 - 5, 53). Conclusion: Persistent pulmonary congestion in AHF patients as assessed by B-line pre-discharge ≥30 is a strong independent predictor of rehospitalization or mortality. LUS could potentially help to guide the timing of discharge from AHF hospitalization, the follow-up scheduling and the therapy tailoring. Further randomized clinical studies are needed to definitely support the routine use of LUS.
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A 2020 study conducted a cohort in Acute heart failure (n=127). Pre-discharge lung ultrasound with ≥30 B-lines vs. Pre-discharge lung ultrasound with <30 B-lines was evaluated on Rehospitalization or mortality (HR 4.71, 95% CI 2.15 - 10.32, p=<0.001). Pre-discharge lung ultrasound with ≥30 B-lines was a strong independent predictor of increased rehospitalization or mortality in acute heart failure patients (HR 4.71; 95% CI 2.15-10.32).
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