A Prospective Pilot Study of Pocket-carried Ultrasound Pre- and Post-Discharge Inferior Vena Cava Assessment for Prediction of Heart Failure Re-hospitalization.
J Card Fail. 2018 Aug 03;:
Authors: Akhabue EI, Pierce JB, Davidson LJ, Prenner SB, Mutharasan RK, Puthumana JJ, Shah SJ, Anderson AS, Thomas JD
Abstract
BACKGROUND: Re-hospitalization for heart failure (HF) is common and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of re-hospitalization; however, the utility of IVC assessment using pocket-carried ultrasound (PCUS) during the transition from discharge to the post-hospitalization follow-up visit (FU) has not been investigated.
METHODS AND RESULTS: IVCmax and IVCmin were measured with PCUS and collapsibility index [IVCCI=(IVCmax-IVCmin)/IVCmax] determined. The primary outcome was 90-day re-hospitalization or death. We prospectively enrolled 49 adults (71±13 years, 51% male, 47% black, 43% preserved EF) hospitalized for HF. Nineteen (39%) patients experienced the outcome. Within the re-hospitalized group, discharge and FU mean IVCmax were both >2.1 cm (2.2±0.5 vs 2.2±0.7) and IVCCI was <50% (44±20% vs 45±24%). Within those not re-hospitalized, FU IVCmax was <2.1 cm (2.1±0.6 vs 1.9±0.6; p=0.038) while IVCCI was >50% at both time points (55±25% vs 62±19%; p=NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (C-statistic=0.73). FU IVCCI<42% was associated with a greater hazard of the outcome independent of admission logBNP [adjusted hazard ratio:6.8 [2.4,19.0], p<0.001)].
CONCLUSIONS: Post-hospitalization IVCCI assessment with PCUS predicts HF re-hospitalization and may identify patients in need of intervention.
PMID: 30081076 [PubMed - as supplied by publisher]