Use of Imaging-Guided Decongestion for Reducing Heart Failure Readmission and Death in High-risk Patients: A multi-site Randomized Trial of a Nurse-led Strategy at Point-of-Care.

BACKGROUND: Nurse-led disease management programs (DMPs) reduce readmission after Acute Decompensated Heart Failure (ADHF). We sought whether readmissions could be further reduced by lung ultrasound (LUS)-guided decongestion pre-discharge and during DMP.

METHODS: Of 290 patients hospitalized with ADHF, 122 at high-risk for readmission or mortality were randomized to receive usual care (UC, n=64) or UC plus intervention (DMP-Plus; n=58), comprising LUS-guided management pre-discharge and at-home follow-up. Residual congestion was identified by ≥10 B-lines detected in 8 lung zones. The outcomes included a composite of readmission and/or mortality at 30- and 90-days, and 90-day HF readmission.

RESULTS: Residual congestion was detected equally among the patient groups. The 30-day composite outcome occurred in 28% DMP-plus patients and 22% UC patients (OR 1.36 [95% CI: 0.59-3.1]; p=0.5) and the 90-day HF readmission outcome occurred in 22% and 31% respectively (OR 0.63 [0.28-1.43]; p=0.3). Residual congestion, identified at pre-discharge LUS in high-risk patients, was associated with early (<14-day) HF readmission (RR 1.19 [1.06-1.32]; p=0.002) and multiple (≥2) readmissions over 90-days of follow-up (RR 1.09 [1.02-1.16]; p=0.001), independent of demographics and comorbidities.

CONCLUSION: Readmission in patients with incomplete decongestion pre-discharge occurs within the first 2-weeks. However, our DMP-plus strategy did not improve the primary outcome.