Results of ACCORDIAN in ACCORD with lower blood pressure begetting lower mortality in patients with diabetes

Abstract

Acute decompensated heart failure (ADHF) is a common reason for admission to the hospital, and readmission is frequent. Multiple factors contribute to rehospitalizations, but inadequate assessment of volume status leading to persistent congestion is an important factor. We sought to determine if focused cardiac ultrasound (FCU) of the inferior vena cava (IVC), as a surrogate of volume status, would predict readmission of ADHF patients after index hospitalization. Patients admitted with a primary diagnosis of ADHF were prospectively enrolled. All patients underwent FCU of the IVC on admission and then daily. 82 patients were enrolled. Patients demonstrated improvement in heart failure physical examination findings and symptoms during the hospitalization. There was a reduction in the size of the IVC and a significant increase in patients with small collapsible vena cava. Logistic regression analysis of physical examination, patient symptoms, and IVC parameters at discharge demonstrated IVC collapsibility and patient reported dyspnea improvement as the only significant variables to predict readmission or emergency department visit. FCU assessment of IVC size and collapsibility may be useful in patients with ADHF to predict risk of being readmitted within 30 days of hospital discharge.

Clinical correlates of hand‐held ultrasound‐guided assessments of the inferior vena cava in patients with acute decompensated heart failure

“…Since clinical decisions were not made based on our US results, and factoring in time and resource constraints involved, we decided to prospectively enroll and follow 130 patients to test the abovementioned hypothesis. Similar studies have been conducted on a smaller scale with variable results in literature …”

“…Another limitation of our study is the small sample size. Although similar studies have been arbitrarily conducted on a smaller scale with variable results in literature, it may be of benefit to conduct larger studies to elicit a smaller effect size, and possibly a clinical utility of hand‐held ultrasound guided diuresis.…”