Key result
Pre-discharge lung ultrasound and clinical congestion score identify residual congestion in ~30% to 39% of ADHF patients.
Why the study?
The study aimed to evaluate pre-discharge residual congestion in patients with ADHF using the Everest Clinical Congestion Score and lung ultrasound, and to correlate these findings with clinical events during the 90-day vulnerable phase after hospital discharge.
Does pre-hospital discharge assessment with the Everest Clinical Congestion Score and lung ultrasound predict 90-day clinical events (intravenous furosemide use, heart failure rehospitalization, and all-cause death) in patients hospitalized for acute decompensated heart failure?
Cohort (n=100)
Does pre-hospital discharge assessment with the Everest Clinical Congestion Score and lung ultrasound predict 90-day clinical events (intravenous furosemide use, heart failure rehospitalization, and all-cause death) in patients hospitalized for acute decompensated heart failure?
Pre-discharge residual congestion is present in roughly one-third of acute decompensated heart failure patients, and the Everest Clinical Congestion Score alongside biomarkers effectively identifies patients at higher risk for post-discharge heart failure events.
Pre-discharge congestion detection may flag ADHF event risk; leaves open whether targeted decongestion improves outcomes.
Background Clinical tools such as the Everest Clinical Congestion Score (ECC) and lung ultrasound (LUS) can be used to assess residual congestion and stratify the prognosis before hospital discharge inpatients with acute decompensated heart failure (ADHF). Objective We aimed at evaluating findings of residual congestion using LUS and ECC in pre-hospital discharge (PHD) patients with ADHF and correlate these findings with the occurrence of significant clinical events in the vulnerable phase (90 days after hospital discharge). Materials and Methods We investigated 100 consecutive patients hospitalized for ADHF, mean age 58.2±13.7 years, 54% male, left ventricular ejection fraction (LVEF) 27.9±13.3 %, length of stay 11.2±5.6 days, evaluated in the PHD with: 1. ECC, considered positive if edema, orthopnea, or jugular venous distension were present; 2. LUS, evaluating 8 lung fields for detection of B-lines (BL), considered positive for congestion if ≥ 1 lung field showed ≥ 3 BL. Serum NT-ProBNP and creatinine levels were also assessed. Clinical outcomes of intravenous furosemide use (IVF), rehospitalization for heart failure (REHF), and death from any cause were monitored in the 90 days after hospital discharge. Univariate and multivariate Cox regression analysis was used to test the correlation between the results of the investigated variables and clinical outcomes. Results The ECC in PHD was positive in 39 (39%) of patients, with detection of jugular venous distension in 30%, orthopnea in 11%, and edema in 4%. The LUS was positive in 30% of patients. The total number of BL was 84, and 23% of patients presented a total of > 7 B lines. There were 26 events in the vulnerable phase, including 16 (16%) IVF, 23 (23%) combined heart failure events (IVF or REHF), and 7 (7%) deaths. Table 1 presents the univariate regression analysis of the correlation between the biomarkers, ECC and LUS, with the outcomes. Table 2 presents the multivariate regression analysis including the variables that showed a positive univariate correlation. Conclusion Our results indicate that residual congestion is found in approximately 1/3 of patients in PHD due to ADHF and that ECC is effective in identifying clinically significant congestion associated with a higher risk of heart failure events after discharge, alongside the biomarkers.
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Valicelli et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=100). Everest Clinical Congestion Score (ECC) and Lung Ultrasound (LUS) vs. Negative congestion findings on ECC or LUS was evaluated on Clinical outcomes of intravenous furosemide use (IVF), rehospitalization for heart failure (REHF), and death from any cause in the 90 days after hospital discharge. Everest Clinical Congestion Score and lung ultrasound detected pre-discharge congestion in 39% and 30% of ADHF patients, with 23% having 90-day HF events and 7% mortality.
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