Echocardiographic evaluation of patients presenting with acutely decompensated heart failure in the setting of dietary or medication noncompliance-Is there a role?

BACKGROUND: Reevaluating patients who are admitted with heart failure (HF) exacerbation using echocardiogram is a common and appropriate indication. However, it is unknown whether it is appropriate to reevaluate such patients when the exacerbation is attributed to patients' noncompliance with self-care behaviors, where the presumption is that the underlying HF biology is stable.

METHODS: Echocardiograms on all patients hospitalized for HF exacerbation attributed to dietary or medication noncompliance were retrospectively assessed for the presence of significant changes from prior echocardiogram.

RESULTS: A total of 559 charts of patients admitted with heart failure exacerbation were reviewed, of which 125 patients (22%) were thought to have dietary or medication noncompliance as the etiology. Fifty-three patients (42%) had a follow-up echocardiogram performed during the index admission. The likelihood of being reevaluated by an echocardiogram during admission was not affected by the clinical service that the patient was admitted to, the patient's gender, or age. Eighty percent of echocardiograms performed within a year of prior study and 78% of echocardiograms performed >1 year revealed at least one significant change. The most common changes identified were an increase in left atrium diameter, worsening of pulmonary artery systolic pressure and worsening ejection fraction. There was no correlation between the time interval of between echocardiograms and the likelihood of a significant change.

CONCLUSIONS: Repeat echocardiograms in patients admitted with HF exacerbation due to noncompliance revealed significant changes in the majority of patients studied. The changes may reflect worsening in cardiac function in addition to the presumed etiology of noncompliance.