Impact of daily bedside echocardiographic assessment on readmissions in acute heart failure: The JECICA randomized trial

Abstract

Acute Heart Failure (AHF) management is challenging, with high morbidity and readmission rates. There is little evidence of the benefit of HF monitoring during hospitalization. We hypothesized that a fast, daily bedside echocardiographic assessment (JetEcho) would improve therapeutic adjustment and outcome. In this prospective, open, two parallel-arm randomized study, 248 patients hospitalized for AHF were assigned to either JetEcho aimed to achieve normal left ventricular filling pressure (LVFP) and volemia, or standard care (SC). The primary outcome was the 30-day readmission rate. Key secondary outcomes were readmission and mortality rates at six months. The primary outcome occurred in 22 of 115 patients (19%) in the JetEcho group and in 17 of 112 patients (15%) in the SC group (relative risk [RR] 1.26; 95% confidence interval [CI], 0.70–2.24; P = 0.4). Six-month readmission rate for cardiac or renal causes was lower in the JetEcho group [ N = 23 (21%)] versus the SC group [ N = 38 (36%)] (RR 0.58; 95%CI, 0.37–0.90; P = 0.01). Six-month mortality did not differ [HR 0.63 (95% CI; 0.3–1.4) P = 0.3] ( Table 1 ) ( Fig. 1 ). The study found no benefit of bedside echography in reducing 30-day readmission rate. However, readmissions for cardiac and renal causes was lower at six months in the JetEcho group, suggesting delayed beneficial effects.