1. Rosenberg, Karen


According to this study:


* Lung and inferior vena cava assessment by nurses can lead to the detection of congestion and help in postdischarge management of patients with heart failure.



Article Content

Residual congestion at discharge can lead to hospital readmission for patients who have heart failure. Researchers conducted a study to determine whether heart failure nurses who had little or no previous scanning experience could obtain useful predischarge lung and vena cava assessment images to provide diagnostic reports predictive of outcomes.


Nurses scanned 240 patients (median age, 77 years; 56% men) who had been admitted for acute decompensated heart failure a median of two days before discharge. Based on the presence of 10 or more B lines, 115 patients were identified as having congestion before discharge. (B lines are vertical lines seen on ultrasound images that indicate physiological changes in the lung tissue.) These patients were more likely to have had previous cardiac operations, long-standing heart failure, and renal impairment compared with patients who weren't found to be congested.


At 90 days, 60 patients were readmitted for heart failure or had died. Of these, 42 had congestion and 18 didn't. Pulmonary congestion increased the odds of 90-day readmission and death 3.3-fold to 4.2-fold, independent of demographics, heart failure characteristics, comorbidities, and heart failure readmission score. After 90 days, patients who were not congested had spent more days alive out of the hospital than patients who were identified as having congestion. Adding B lines to a previously developed heart failure risk score provided a net reclassification improvement for predicting 90-day readmission or death.


The authors note that the presence of B lines in patients who have heart failure identifies the risk of readmission but doesn't necessarily indicate congestion. Clinical judgment, they advise, is always needed before starting diuresis.


Zisis G, et al J Am Coll Cardiol 2022;80(5):513-23.