Ultrasound helps improve follow-up outcomes after heart failure exacerbation

  • Rivas-Lasarte M & al.
  • Eur J Heart Fail
  • 31 Oct 2019

  • International Clinical Digest
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Takeaway

  • In a proof-of-concept study, outpatients recently hospitalised with heart failure (HF) had better follow-up outcomes if doctors based treatment decisions on lung ultrasound (LUS).
  • Large clinical trials are needed.

Why this matters

  • Pulmonary congestion is the most important reason these patients land in the hospital, yet it is hard to assess clinically. 

Key results

  • LUS vs standard group: 
    • Primary outcome: 23% (n=14) vs 40% (n=25; P=.045).
    • Primary outcome: HR, 0.518 (95% CI, 0.268-0.998; P=.049).
    • Number needed to treat to avoid an event: 5 (95% CI, 3-62).
  • Difference attributable mainly to fewer urgent visits for worsening heart failure in LUS-guided group.
  • Similar between-group levels of NT-proBNP and QoL.
  • LUS-guided group received more loop diuretics and had greater improvement in the 6-minute walking test.

Study design

  • Single-blind 6-month clinical LUS-HF trial of adults hospitalised for HF (n=123).
  • After discharge, participants were randomly assigned to LUS-guided vs standard follow-up. 
  • They were seen at 14, 30, 90, and 180 days postdischarge.
  • For LUS group, physicians were encouraged to make diuretic decisions based on B-lines.
  • Outcomes: composite of urgent visit, hospitalisation for worsening HF, and all-cause mortality.
  • Funding: Spanish governmental, nonprofit funders. 

Limitations

  • Single-centre study.
  • Wide confidence ratios and low fragility index.