After being sent to the hospital for acute decompensated heart failure (ADHF), residual congestion seen with portable ultrasonography may be linked to a higher risk of readmission and mortality. However, consistent usage by non-experts providing clinical care was required for effective implementation. For a study, researchers sought to find out whether heart failure (HF) nurses could perform a pre-discharge lung and inferior vena cava (IVC) assessment (LUICA) that might forecast 90-day outcomes.
In the multisite, prospective, observational investigation, HF nurses used a 9-zone LUICA protocol to scan 240 patients with ADHF (median age: 77; 56% men). Independent nurses who were oblivious to clinical details and results evaluated the obtained photographs. Patients were classified as either congested (n=115) or not congested (n=125) using a B-line cut-off of 10.
Patients with congestion were more likely to have had prior cardiac procedures, long-term HF (>6 months), and renal impairment. At 90 days, 42 congested patients (37%) experienced HF readmission or death, compared to 18 noncongested patients (14% ). At 30-day HF readmission or mortality risk (OR: 3.86; 95% CI: 1.65-8.99; P <0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P< 0.01) and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P< 0.01), pulmonary congestion increased. Independent of demographics, HF features, comorbidities, and event risk score, pulmonary congestion increased the 90-day chances of HF readmission and/or mortality by 3.3 to 4.2-fold (P <0.01). Over a period of 90 days, congested patients had fewer days alive outside of the hospital (78.3±21.4 days vs. 85.5±12.4 days; P <0.01).
For the identification of predischarge residual congestion, LUICA can be a very effective method. In addition, the results of ADHF can be predicted by the diagnostic reports and photos that HF nurses can collect.
Reference: jacc.org/doi/10.1016/j.jacc.2022.04.064
