Author + information
- Mohammad-Ali Jazayeria,b,
- Holly Rodina,b,
- Melissa Madsena,b,
- Steven Goldsmitha,b,
- Bradley Barta,b and
- Gautam Shroffa,b
Background: Accurate assessment of decongestion prior to hospital discharge for heart failure (HF) is critical to improve outcomes and prevent readmission. We compared three methods of assessing decongestion at discharge: clinical exam, hand carried ultrasound (HCU) and patient symptoms.
Methods: HF patients in a teaching hospital were prospectively recruited on day of discharge. An internal medicine resident trained in echocardiographic assessment of right and left (R/L) sided measures of congestion evaluated guideline specified echocardiography parameters blinded to clinical exam. Treatment teams blinded to HCU were surveyed for clinical assessment of discharge R/L filling pressures. Each patient filled out a validated assessment of symptom status. Assessments were dichotomized and compared with receiver operating characteristic curves and Pearson's correlation coefficient.
Results: See Table. Among 38 patients enrolled over 8 weeks, there was no correlation between clinical exam, HCU R/L volume indices and patient symptoms (AUC 0.54 – 0.67). R/L filling pressures assessed by clinical exam were correlated (p < 0.001). Nearly 53% of patients at discharge had plethoric IVC without collapsibility indicating elevated RA pressure.
Conclusions: This study highlights the poor correlation between routinely used measures of decongestion in HF. A strategy of HCU for R/L filling pressure assessment prior to discharge appears feasible and may provide a more objective guide for discharge planning.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights From Echocardiography Use
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1291-230
- 2017 American College of Cardiology Foundation