Comparison of Hand-Carried Ultrasound Assessment of the Inferior Vena Cava and N-Terminal Pro-Brain Natriuretic Peptide for Predicting Readmission After Hospitalization for Acute Decompensated Heart Failure

Goonewardena, Sascha N.; Gemignani, Anthony; Ronan, Adam; Vasaiwala, Samip; Blair, John E.; Brennan, J. Matthew; Shah, Dipak; Spencer, Kirk T.

doi:10.1016/j.jcmg.2008.06.005

Cited by 152 publications

(120 citation statements)

References 25 publications

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“…Studies include evaluations of clinical parameters such as angina, low systolic blood pressure, edema levels, elevated jugular venous pressure, age, depressive symptoms, and the presence of coronary heart disease and pacemakers 13. Serum biomarkers have received the most attention, as simple objective measurements that can be and are routinely performed at admission, such as BNP,14, 15, 16 blood urea nitrogen,17, 18 hemoglobin and hematocrit,19 cystatin,15 and cardiac troponin 15. Hemodynamic predictors have also been evaluated to more specifically determine volume status to prevent premature hospital discharges and to reduce readmissions.…”

Section: Discussionmentioning

confidence: 99%

“…Recently the concept of impedance, which correlates to pulmonary artery wedge pressures, as measured by cardiac resynchronization therapy defibrillator devices, has shown promise but requires an implanted device 24. Simpler bedside ultrasound devices have been used to measure hepatic venous flow25 and inferior vena cava collapsibility index16, 26, 27 as measures of RAP and central venous pressure, respectively. Ultimately, no technique has emerged as a validated and reproducible predictor of early 30‐day readmission following treatment for ADHF.…”

Section: Discussionmentioning

confidence: 99%

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Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Simon

Schnatz

Romeo

et al. 2018

JAHA

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BackgroundHeart failure is one of the most costly diagnosis‐related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross‐sectional area (CSA) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure.Methods and ResultsPatients admitted with acute decompensated heart failure (ADHF) underwent ultrasound measurements of the right internal jugular vein at end‐expiration and during the strain phase of Valsalva to determine a percentage of CSA change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of CSA change predictive of right atrial pressure (RAP) ≥12 mm Hg. Images of admitted ADHF patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a <66% CSA change predicted RAP ≥12 mm Hg (positive predictive value: 87%; P<0.05, receiver operating characteristic curve). Elevated admission RAP by percentage of CSA change normalized by discharge (P<0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the cutoff value of 66% CSA change, normal RAP at discharge had 91% predictive value for patients avoiding 30‐day readmission (P<0.05).ConclusionsThis bedside ultrasound technique strongly correlates to invasive RAP measurement in ADHF patients, identifies restoration of euvolemia, and is predictive of 30‐day ADHF readmission. This tool could help guide inpatient ADHF treatment and may lead to reduced readmissions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Simon

Schnatz

Romeo

et al. 2018

JAHA

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“…Given the limited number of primary outcome events, we used age, IVC diameter, and log NT-proBNP in the multivariate regression analysis based on past studies showing prognostic significance of these variables. 6,[22][23][24][25][26][27][28] Optimal cutoff values for IVC diameter for death and readmission prediction were determined by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC) for different IVC diameters. NT-proBNP values were log-transformed to minimize skewing as reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…6,37 Goonewardena et al showed a 41.3% readmission rate at 30 days in patients with severely reduced left ventricular ejection fraction (mean 29%), and readmitted patients had an IVC max diameter >2 cm and an IVC collapsibility <50% on admission and discharge. 6 Carbone et al demonstrated absence of improvement in the minimum IVC diameter from admission to discharge using hand-carried ultrasound in patients with ischemic heart disease (ejection fraction 33%) predicted readmission at 60 days. 38 Hospital readmission rates in our study are consistent with these previously published studies.…”

Section: Figmentioning

confidence: 99%

“…The selection of variables (age, NTproBNP, and IVC diameter) was based on prior studies demonstrating their prognostic value. 6,22,25 Due to the low event rate (n 5 11), we could not include in the regression model other variables that differed significantly between nonsurvivors and survivors, including NYHA class, presence of atrial fibrillation, and use of b-blockers.…”

Section: Figmentioning

confidence: 99%

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Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247‐bed urban teaching hospital in Spain PATIENTS Ninety‐seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90‐day all‐cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180‐day all‐cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90‐day follow‐up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90‐day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21‐28.10; P = 0.025) and 90‐day readmission (HR: 3.20; 95% CI: 1.24‐8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90‐day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778–784. © 2016 Society of Hospital Medicine

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Time to Add a Fifth Pillar to Bedside Physical Examination

2018

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Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.

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Comparison of Hand-Carried Ultrasound Assessment of the Inferior Vena Cava and N-Terminal Pro-Brain Natriuretic Peptide for Predicting Readmission After Hospitalization for Acute Decompensated Heart Failure

Cited by 152 publications

References 25 publications

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Time to Add a Fifth Pillar to Bedside Physical Examination

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