Investigating Reduction of aCute heArt Failure Readmission With Lung UltraSound-preliminary Trial

Investigating Reduction of aCute heArt Failure Readmission With Lung UltraSound-preliminary Trial (Pre-IcarUS)

In Switzerland 15% of discharged patients are readmitted within 30 days. Acute heart failure is the leading cause of hospital admission and one of the most frequent reasons for re-admission, mainly because of congestion-driven symptoms. Residual congestion is noted in 10%-15% of patients at discharge and is associated with an increased risk of re-admission and mortality. Lung ultrasound outperforms both chest X-ray and physical examination in detection of lung congestion. Several semiquantitative scanning protocols exist for quantifying congestion. The aim of this study is to compare for the first time two widely used lung ultrasound protocols, one exhaustive (28-points) and one simplified (8-points), in real-time settings. The focus is placed on reproducibility (expert-beginner interobserver concordance), feasibility (time consumption for images acquisition and interpretation) and performance (detection of B-lines clearing) of both scores. Semi-quantitative method is expected to have better feasibility with similar reproducibility and performance.

Inclusion Criteria:

• Diagnosis of acute heart failure on admission chart (primary or secondary diagnosis)
• Admission from the emergency room to a general internal medicine ward
• Presentation of acute heart failure according to European Society of Cardiology :
• Presence of ≥1 symptom or sign based on admission chart review and
• Raised value of N terminal-pro-brain natriuretic peptide (>300 ng/l)

Exclusion Criteria:

• Interstitial lung disease, lung cancer or metastasis, acute respiratory distress syndrome, pulmonary contusion, previous lung surgery
• Inability or unwillingness to give consent
• Presence of oligo-anuric end stage renal disease