Can point of care ultrasound (POCUS), in the general ward and in primary care, reduce 30-day hospital readmission (HR) in a heart failure (HF) population?

Background: about 25% of patients admitted for HF are readmitted to hospital within 30 days. Fluid congestion is the leading cause for short-term readmission. Lung ultrasound (LUS) has become widely used to assess pulmonary congestion of cardiac origin for hospitalized patients on admission and before discharge but also for patients with HF undergoing outpatient follow-up. Inferior vena cava ultrasonography (IVCUS) seems also to be a useful tool in the care of patients with chronic HF. General practitioners (GPs) can safely use POCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. Furthermore, they have expressed a need for greater training to diagnose and manage HF. An effective advanced fluid management programme, consisting in an intervention providing tailored therapy guided by intravascular volume assessment, is associated with improving readmission and mortality in HF. However, experts report long waiting lists for HF clinics and emphasize that scheduled follow-up appointments with a cardiologist do not regularly occur within two weeks of discharge, as recommended in guidelines. Purpose: to assess if POCUS, including LUS and IVC collapse index (IVCCI), can help in-hospital management in the general ward and if GPs can early identify signs of fluid overload after discharge, providing early referral and optimal therapy according to 2021 ESC guidelines. Methods: observational pilot study to test routine POCUS performed on hospital admission, before discharge and after 2 weeks in the GP ambulatory setting, after an in-hospital training period. 30-day HR was retrospectively compared to the clinical standard. Results: among 250 consecutive SARS-CoV-2 negative patients admitted to the department of internal medicine, 56 (22.4%) have been hospitalized for acute decompensated HF (17.8% HFrEF, 26.8%, HFmrEF, 55.4% HFpEF). 17 patients (30% M/F 6/11: group 1) underwent POCUS, while 39 patients (70% M/F 25/14, group 2) the standard management. Mean age difference (group1: 80.6±9.6 vs group2: 82.8±8.2) as well as comorbidities were not significant among groups (t-test p<0.19), while mean length of stay (MLS) for group1 (6.5±2.9 days) vs group2 (12±6.2 days) was significant (t-test p<0.001). LUS on discharge excluded persistent congestion in 76.5% (B-lines ≥ 3: 23.5%, yet 75% of these patients had no findings on ascultation), while IVCCI was >50%, 30-50%, <30% respectively in 52.9%,17.6% and 29.4%). 3 patients were evaluated after 2 weeks by GP. The 30-day HR was 5.8% (group1) vs 12.8% (group2) (χ2 test p<0.0012). Conclusions: POCUS seems to have contributed to reduce MLS, encouraging attainment of an optimal volume status at discharge and prescription of an optimal therapy. LUS and IVCUS are simple tools which may be performed soon after discharge by GP, contributing to reduce 30-day HR improving post discharge quality of care.

Bedside multi-organ point-of-care ultrasound (PoCUS) and focused cardiac ultrasound (FoCUS) experience in a multidisciplinary low intensity COVID-19 department during the current pandemic scenario

Background: COVID-19 has caused devastation in the past year. PoCUS including lung ultrasound (LUS) and FoCUS as a clinical adjunct has played a significant role in medical management of these patients. The use of US is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19. Limitations due to insufficient data are opportunities for future research. Aim of the study: To evaluate PoCUS and FoCUS in daily practice, in order to better understand their role in SARS-CoV-2 positive patients. Materials and Methods: Retrospective evaluation in a multidisciplinary COVID 19 department during the current pandemic scenario. PoCUS and FoCUS activity have been performed using a multi-frequency probes equipment. Results: 70 SARS-CoV-2 positive patients (M/F 34/36, mean age 68.1±5.5) have been admitted in a multidisciplinary low intensity (Pa O2/Fi O2 ≥300) COVID 19 department from December 27th, 2021 for 36 consecutive days. 47% had pneumonia, 78% of which were no-vax patients. 47% were discharged home, 7.1% transferred to the intensive care unit for clinical deterioration, 8.6% to the post-acute ward, while 4.3% died. PoCUS and FoCUS were performed in 55.3% (internal US 38.4%, CUS 30.8%, procedures 30.8%). 2 newly diagnosed gastrointestinal neoplasms have been identified. Conclusions: in SARS-CoV-2 positive patients PoCUS and FoCUS are rapid, bedside, goal-oriented, diagnostic test that are used to answer specific clinical questions, not only for pulmonary disease but also to better evaluate relevant underlying comorbidities.