Peripheral Venous Pressure to Predict Congestive Heart Failure Readmission

Abstract

Introduction Acute decompensated heart failure (ADHF) readmission rates are high and act as a burden to both the patient and the healthcare system. Non-invasive measures of hemodynamic status are limited in accuracy, leading to patients being discharged with residual congestion and a higher likelihood of subsequent readmission for ADHF. Peripheral venous pressure (PVP) measurement involves transducing a peripheral intravenous (PIV) catheter and may serve as a minimally invasive method of determining hemodynamic status in patients with ADHF. PVP measurements have been shown to correlate with CVP measurements in heart failure patients, but the clinical relevance of this has not yet been established. We sought to examine if PVP measurements may predict heart failure readmission. Methods A prospective feasibility study was conducted from July to December 2018. Patients admitted with ADHF were enrolled on day-of-discharge. Using a standard pressure transducer leveled to the phlebostatic access, measurement of PVP was performed at the bedside using a previously-inserted PIV. The electronic medical record was reviewed for subsequent readmissions. The primary end-point was readmission at 30 days post-discharge. Results 29 patients were enrolled. The mean age of participants was 65.6 +/- 10.8 years. 66% of patients were male and 55% of patients were black. 72% of patients had a reduced ejection fraction (EF) and 28% had a preserved EF. At the time of discharge, the mean PVP was 11.6 +/- 4.9 mmHg. 5 patients (17%) were readmitted within 30 days. Mean PVP for those readmitted was 12.0 +/- 2.1 mmHg vs 11.5 +/- 5.3 mmHg for those without readmission (difference of the means 0.5 mmHg, p= 0.86). PVP was not significantly impacted by whether a 22-gauge or 20-gauge PIV was used (difference of means 2.3 mmHg, p= 0.51). Waveform analysis on a subset of patients showed lower PVP in those with a sinusoidal waveform as opposed to a flatline or static waveform (12.8 vs. 17.4 mmHg, p=0.32). Conclusion In this small feasibility study, few patients were readmitted for heart failure in 30 days. PVP was similar among the 5 patients readmitted with ADHF. PVP measurement was readily obtainable and PVP was not significantly impacted by PIV gauge. Further study of this clinical application to PVP measurement is warranted.