Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

Abstract

Acute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees. Keywords: heart failure; point of care ultrasound; lung ultrasound

The Conundrum of Volume Status Assessment: Revisiting Current and Future Tools Available for Physicians at the Bedside

“…In the absence of a gold standard test that is reliable and easily accessible to assist with decision-making, assessment of volume status can be challenging for physicians [ 17 ]. Many measures have been suggested to play the role of gold standard test given their increased sensitivity and specificity compared to history and physical examination (e.g., serum aldosterone and norepinephrine, bioelectrical impedance, radioisotope techniques to directly measure blood volume, central venous pressure [CVP], pulmonary artery catheterization to measure right atrial pressure and pulmonary capillary wedge pressure [PCWP], and transpulmonary thermodilution) [ 2 , 18 - 20 ].…”