Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure

Abstract

ObjectivePulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.MethodsIn this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.ResultsA total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.ConclusionsLUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.

Ultrasound imaging of congestion in heart failure: examinations beyond the heart

“…Ultimately, randomised trials are required to demonstrate that treatment guided by sonographic assessment in HF is safe, improves symptoms and quality of life and long‐term outcomes. Trials are currently ongoing for LUS in patients during an admission for acute HF (NCT03136198 and NCT03259165), after hospital discharge and in the outpatient clinic; preliminary results are encouraging 80–82 …”

“…Trials are currently ongoing for LUS in patients during an admission for acute HF (NCT03136198 and NCT03259165), after hospital discharge and in the outpatient clinic; preliminary results are encouraging. [80][81][82] Finally, with the advent of COVID-19 the sonographic assessment of patients with suspected HF who require hospitalisation has become more complex. For instance, right ventricular and IVC dilatation could be due to right ventricular failure in the setting of acute respiratory distress syndrome or pulmonary embolism associated with a COVID-19 infection.…”

Hospitalist Perceptions of Barriers to Lung Ultrasound Adoption in Diverse Hospital Environments

“…Of the 27 internal medicine-hospitalists invited, a total of 22 (15 adopters, 7 nonadopters) participated in interviews that lasted 30 to 45 minutes (Table 3). Median years post-residency of participants was 10.5 [IQR: [5][6][7][8][9][10][11][12][13][14][15]. Recruited hospitalists had a broad spectrum of LUS experience ranging from novices to experts who routinely used LUS for diagnosis of multiple disease processes, including pneumothorax, pneumonia, pleural effusion, and pulmonary edema.…”

“…In recent years, there has been increasing interest in integrating point of care ultrasound (POCUS), ultrasound that is performed and interpreted at the bedside by a treating clinician, into diagnostic pathways within internal medicine. In particular, point of care lung ultrasound (LUS) has emerged as an accurate and practical imaging modality for the assessment of undifferentiated dyspnea and monitoring of volume status in patients with heart failure [1][2][3][4][5][6][7][8]. In light of the growing evidence of its utility, multiple professional societies now endorse LUS use in acute care settings [1,9].…”

Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center

“…Point of care ultrasound (POCUS) is ultrasound imaging that is acquired and interpreted by a clinician at the bedside. Driven by growing clinical evidence [ 1 , 2 , 3 ], there is increasing interest in the integration of POCUS use into routine clinical care by multiple specialties. Though emergency medicine [ 4 ] and critical care [ 5 , 6 ] were the first specialties to integrate POCUS into their training standards, multiple other medical and surgical specialties are following their lead, including internal and hospital medicine whose professional societies now officially endorse diagnostic POCUS use [ 7 , 8 ].…”