B-Lines Value on Lung Ultrasound and EVEREST Score Pre-Discharge as A Predictor of Rehospitalization and Total Mortality Post Hospitalization Due to Acute Heart Failure

Abstract

Background: The high rate of rehospitalization in the vulnerable phase after treatment for acute heart failure (AHF) is caused by persistent hemodynamic congestion, even though the patient has experienced clinical improvement before being discharged. The B-lines value on Lung Ultrasound is a hemodynamic parameter that has the potential to determine the post-treatment prognosis of patients with AHF, while the EVEREST score is a marker of congestion which consists of several parameters used to assess congestion clinically. Methods: Patients treated for AHF with varying ejection fraction (EF) were included in this prospective cohort study. Data on demographics, comorbidities, pre-discharge therapy and pre-discharge echocardiographic parameters were collected. The pre-discharge B-lines value and EVEREST score were calculated a maximum of 24 hours before the patient was discharged. The outcomes studied were rehospitalization and total mortality within 60 days. Results: A total of 66 samples with various EF were included until the end of the study (15 HFpEF, 8 HFmrEF, and 43 HFrEF, mean age 57.14 ± 14.68 years). During the 60-day follow-up period, 19 samples (28.9%) experienced rehospitalization and total mortality. Both the B-lines value (AUC 0.716; 95%CI 0.581-0.851; p<0.006) and the EVEREST score (AUC 0.675; 95%CI 0.542-0.807%; p<0.027) served as predictors of rehospitalization and total mortality. The regression model showed that the pre-discharge B-lines score was ≥9 (adjusted HR 4.865; 95%CI 1.749-13.534; p=0.002) and the pre-discharge EVEREST score ≥2 (adjusted HR 3.694; 95%CI 1.211-11.262; p=0.022) played an independent role as a predictor of rehospitalization and total mortality, regardless of BMI, diabetes mellitus, renal impairment or TAPSE. Conclusion: The pre-discharge B-line value and EVEREST score can be applied to stratify the risk of rehospitalization and total mortality after treatment for patients with AHF.