The Role of Hand Carried Ultrasound in Guiding Management of Challenging Heart Failure Patients

Abstract

Purpose Accurate assessment of volume status and estimation of central venous pressure is critical in directing management of acute heart failure (HF) patients . We evaluated the impact of hand carried ultrasound (US) in guiding therapy for HF patients with uncertain volume status on physical examination (PE) or with worsening serum creatinine (Cr). Methods We prospectively included patients admitted to the hospital with acute HF exacerbation and had uncertain volume status or worsening Cr to undergo US-guided management between January 2017 to October 2018. HF team provided initial management plan based on standard of care (PE, symptoms and lab results), then they were provided with US estimation of intravascular volume (by assessing inferior vena cava size and respiratory variation, right and left jugular veins size, respiratory variation and compressibility). Primary outcome was percent change of initial plan after providing US results. Logistic regression was used to compare the percent change in plan by HF type. Results A total of 151 (Age 64±15,46% females, 78% white) patients were included during study duration. 47(31%) patients had HF with preserved ejection fraction (HFpEF), and 104 (69%) patients had HF with reduced ejection fraction (HFrEF). A change in plan was observed in 77.5% of the patients after using ultrasound. No difference in percent change of plan between HFrEF (81%) and HFpEF patients (70%), (OR 1.7, 95% CI: 0.73, 3.9, p= 0.2). Conclusion Ultrasound management of patients with HF and uncertain volume status or worsening Cr may significantly impact management decisions regardless of HF type, Further studies are needed to explore whether these changes improve outcomes of this population.