Key result
POCUS-guided intensified decongestion shows no benefit over standard care for 6-month death or HF readmission.
Why the study?
Residual congestion drives early events after hospitalization for ADHF, yet physical examination detects it poorly. Whether a POCUS-guided early decongestion strategy is associated with 6-month outcomes in ADHF patients managed on an internal medicine ward was examined.
Does a point-of-care ultrasound–guided early intensified intravenous furosemide decongestion strategy reduce 6-month all-cause death or heart failure readmission in patients hospitalized with acute decompensated heart failure on an internal medicine ward?
Cohort (n=94)
No
Does a point-of-care ultrasound–guided early intensified intravenous furosemide decongestion strategy reduce 6-month all-cause death or heart failure readmission in patients hospitalized with acute decompensated heart failure on an internal medicine ward?
In patients hospitalized with acute decompensated heart failure on an internal medicine ward, early diuretic intensification guided by a single admission IVC ultrasound scan did not reduce 6-month mortality or heart failure readmission compared to standard care.
Does not support POCUS-guided decongestion on wards; leaves open whether randomized IVC-guided trials would reduce ADHF events.
Background Residual congestion is a major driver of early events after hospitalization for acute decompensated heart failure (ADHF), and physical examination detects it poorly. We examined whether a point-of-care ultrasound (POCUS)–guided early decongestion strategy was associated with 6-month outcomes in patients with ADHF managed on an internal medicine ward. Methods In this single-center comparative cohort study, patients with ADHF managed with a POCUS-guided strategy were enrolled prospectively. In this strategy, an inferior vena cava (IVC) diameter > 2.1 cm with collapsibility < 50% triggered 200 mg of intravenous furosemide in the first 24 hours. Patients with ADHF who did not undergo POCUS in the clinic were retrospectively selected as controls. The primary outcome was a composite of all-cause death or heart failure (HF) readmission within 6 months after discharge, ascertained from hospital records and analyzed with Cox regression. Results Of 100 patients, 94 had verifiable follow-up (46 POCUS-guided, 48 controls; mean age 75.4 years; 55% women). The primary outcome occurred in 25 (54%) POCUS-guided patients and 19 (40%) controls (hazard ratio [HR] 1.49, 95% CI 0.82–2.71; adjusted HR 1.36, 95% CI 0.73–2.53). HF readmission (24% vs. 19%), death (37% vs. 31%), 30-day outcomes and length of stay did not differ significantly. Conclusions In this real-world cohort, POCUS-guided early intensified decongestion was not associated with improved 6-month outcomes. Adequately powered randomized trials that separate ultrasound assessment from diuretic intensity are needed before this strategy is adopted.
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Genc¹ et al. (2026) conducted a cohort in Acute decompensated heart failure (n=94). Point-of-care ultrasound (POCUS)–guided early decongestion strategy (200 mg IV furosemide in first 24 hours triggered by IVC diameter > 2.1 cm with collapsibility < 50%) vs. Standard clinical assessment with routine initial therapy (100 mg intravenous furosemide in the first 24 hours) was evaluated on Composite of all-cause death or heart failure readmission within 6 months after discharge (HR 1.49, 95% CI 0.82-2.71, p=0.152). POCUS-guided early intensified decongestion did not improve 6-month death or HF readmission vs standard care in ADHF (54% vs 40%; HR 1.49, 95% CI 0.82-2.71).
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