What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (n=100). Intervention: Subclinical residual congestion on POCUS vs. No subclinical residual congestion on POCUS. Primary outcome: 30-day readmission due to ADHF (OR 13.19, 95% CI 2.7-62.6).

November 15, 2024Open Access

Subclinical Congestion Evaluated by Point of Care Ultrasound (POCUS) at Discharge Predicts Readmission in Patients with Acute Heart Failure: Prognostic Cohort Study

SVSergio Velasco‐MalagónUniversidad de Valladolid EAEstivalis Acosta‐GutiérrezHospital Universitario Nacional de Colombia JNJosé Atilio Núñez-RamosUniversidad del Norte

Key Result

Subclinical residual congestion evaluated by point-of-care ultrasound at discharge was associated with a significantly higher risk of 30-day readmission in patients with acute heart failure (OR 13.19).

Study Design

Type

Cohort (n=100)

Multicenter

Structured PICO

Does subclinical congestion evaluated by POCUS at discharge predict 30-day readmission in patients with acute decompensated heart failure?

Population

100 adult patients (median age 78, 55% female) hospitalized for acute decompensated heart failure who were clinically decongested at discharge, followed for 30 days.

Exposure

Point of care ultrasound (POCUS) using lung ultrasound (LUS) and portal vein pulsatility (PVP) to assess residual congestion at discharge.

Outcome

30-day rehospitalizationhard clinical

Subclinical congestion detected by POCUS (lung ultrasound and portal vein pulsatility) at discharge strongly predicts 30-day readmission in patients with acute decompensated heart failure.

Main Result

Odds Ratio: 13.19 (95% CI 2.7–62.6)

Limitations

Single-center cohort study with a relatively small sample size, limiting generalizability
POCUS evaluations were performed by a single expert, which may affect the application of the results
Mortality analysis was not performed due to the low number of outcomes
Potential scenarios where lung ultrasound, inferior vena cava, and portal vein pulsatility may not be interpretable

Abstract

Background: Heart failure (HF) is a complex entity that increases the risk of adverse outcomes. Point of care ultrasound (POCUS) allows easy lung and systemic venous congestion identification. Using ultrasound to detect sub-clinical congestion at discharge may help predict readmissions and mortality. Outcomes: The primary outcome was to address 30-day rehospitalization, and as a secondary outcome we investigated readmission and mortality in patients with residual congestion assessed with POCUS. Methods: A prospective prognostic cohort study was conducted at a tertiary-level institution in Colombia. Patients with acute decompensated heart failure (ADHF) at discharge were evaluated using POCUS through lung ultrasound (LUS), portal vein pulsatility (PVP), and a composite assessment of residual congestion. Inclusion criteria were ADHF, over 18 years old, with a “warm-wet” clinical profile. POCUS was performed using an ultraportable device using LUS and PVP. Statistical analysis used logistic regression models to estimate the association between ultrasound congestion and outcomes. Results: A total of 100 patients were included. The population was mostly female, with a median age of 78 years; 59% were hypertensive, and 39% had type 2 diabetes. Median NT-ProBNP was 3878 pg/ml. At discharge, 55% of patient had an inferior vena cava (IVC) over 2 cm, 54% had interstitial syndrome, and 41% had PVP >30%. Regarding 30-day readmission, we found an odds ratio (OR) 7.22 (95% CI 2.7-19.3) for interstitial syndrome; for PVP >30%, an OR 24.61 (95% CI 7.7-78.1) and an OR 13.19 (95% CI 2.7-62.6) for composite of residual congestion. Conclusion: Patients with ADHF and sub-clinical congestion, evidenced in LUS and PVP, were more likely to have readmission within 30 days of discharge. These findings should be confirmed with clinical trials to assess the effectiveness of a POCUS-guided treatment.

Ask AI

Helpful

Bookmark

View Full Paper