A Prospective Pilot Study of Pocket-Carried Ultrasound Pre- and Postdischarge Inferior Vena Cava Assessment for Prediction of Heart Failure Rehospitalization

Ehimare Akhabue*, Jacob B. Pierce, Laura J Davidson, Stuart B. Prenner, R Kannan Mutharasan, Jyothy John Puthumana, Sanjiv J Shah, Allen Sawyer Anderson, James David Thomas

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated. Methods and Results: IVC max and IVC min were measured with the use of PCUS, and the collapsibility index (IVCCI = [IVC max − IVC min ]/IVC max ) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51% male, 47% black, 43% preserved ejection fraction) hospitalized for HF. Nineteen patients (39%) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVC max were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50% (44 ± 20% and 45 ± 24%). Within those not rehospitalized, FU IVC max was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P =.038) and IVCCI >50% at both time points (55 ± 25% and 62 ± 19%; P = NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (c-statistic = 0.73). FU IVCCI <42% was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio = 6.8; 95% confidence interval 2.4–19.0; P <.001). Conclusions: Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention.

Original languageEnglish (US)
Pages (from-to)614-617
Number of pages4
JournalJournal of Cardiac Failure
Volume24
Issue number9
DOIs
StatePublished - Sep 1 2018

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Inferior Vena Cava
Heart Failure
Prospective Studies
Brain Natriuretic Peptide
Confidence Intervals

Keywords

  • Inferior vena cava
  • heart failure
  • pocket-carried ultrasound
  • rehospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{bd7a6aaa237f42fa91b4e0453bc132d2,
title = "A Prospective Pilot Study of Pocket-Carried Ultrasound Pre- and Postdischarge Inferior Vena Cava Assessment for Prediction of Heart Failure Rehospitalization",
abstract = "Background: Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated. Methods and Results: IVC max and IVC min were measured with the use of PCUS, and the collapsibility index (IVCCI = [IVC max − IVC min ]/IVC max ) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51{\%} male, 47{\%} black, 43{\%} preserved ejection fraction) hospitalized for HF. Nineteen patients (39{\%}) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVC max were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50{\%} (44 ± 20{\%} and 45 ± 24{\%}). Within those not rehospitalized, FU IVC max was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P =.038) and IVCCI >50{\%} at both time points (55 ± 25{\%} and 62 ± 19{\%}; P = NS). FU IVCCI below an optimal cutoff of 42{\%} had modest discrimination alone (c-statistic = 0.73). FU IVCCI <42{\%} was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio = 6.8; 95{\%} confidence interval 2.4–19.0; P <.001). Conclusions: Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention.",
keywords = "Inferior vena cava, heart failure, pocket-carried ultrasound, rehospitalization",
author = "Ehimare Akhabue and Pierce, {Jacob B.} and Davidson, {Laura J} and Prenner, {Stuart B.} and Mutharasan, {R Kannan} and Puthumana, {Jyothy John} and Shah, {Sanjiv J} and Anderson, {Allen Sawyer} and Thomas, {James David}",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.cardfail.2018.07.461",
language = "English (US)",
volume = "24",
pages = "614--617",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "9",

}

TY - JOUR

T1 - A Prospective Pilot Study of Pocket-Carried Ultrasound Pre- and Postdischarge Inferior Vena Cava Assessment for Prediction of Heart Failure Rehospitalization

AU - Akhabue, Ehimare

AU - Pierce, Jacob B.

AU - Davidson, Laura J

AU - Prenner, Stuart B.

AU - Mutharasan, R Kannan

AU - Puthumana, Jyothy John

AU - Shah, Sanjiv J

AU - Anderson, Allen Sawyer

AU - Thomas, James David

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated. Methods and Results: IVC max and IVC min were measured with the use of PCUS, and the collapsibility index (IVCCI = [IVC max − IVC min ]/IVC max ) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51% male, 47% black, 43% preserved ejection fraction) hospitalized for HF. Nineteen patients (39%) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVC max were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50% (44 ± 20% and 45 ± 24%). Within those not rehospitalized, FU IVC max was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P =.038) and IVCCI >50% at both time points (55 ± 25% and 62 ± 19%; P = NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (c-statistic = 0.73). FU IVCCI <42% was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio = 6.8; 95% confidence interval 2.4–19.0; P <.001). Conclusions: Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention.

AB - Background: Rehospitalization for heart failure (HF) is common, and subclinical congestion may be present at discharge. Larger inferior vena cava (IVC) size and lower collapsibility at discharge assessed via bedside ultrasound are predictive of rehospitalization; however, the utility of IVC assessment with the use of pocket-carried ultrasound (PCUS) during the transition from discharge to the posthospitalization follow-up visit (FU) has not been investigated. Methods and Results: IVC max and IVC min were measured with the use of PCUS, and the collapsibility index (IVCCI = [IVC max − IVC min ]/IVC max ) was determined. The primary outcome was 90-day rehospitalization or death. We prospectively enrolled 49 adults (71 ± 13 years of age, 51% male, 47% black, 43% preserved ejection fraction) hospitalized for HF. Nineteen patients (39%) experienced the outcome. Within the rehospitalized group, discharge and FU mean IVC max were both >2.1 cm (2.2 ± 0.5 and 2.2 ± 0.7) and IVCCIs <50% (44 ± 20% and 45 ± 24%). Within those not rehospitalized, FU IVC max was ≤2.1 cm (2.1 ± 0.6 and 1.9 ± 0.6; P =.038) and IVCCI >50% at both time points (55 ± 25% and 62 ± 19%; P = NS). FU IVCCI below an optimal cutoff of 42% had modest discrimination alone (c-statistic = 0.73). FU IVCCI <42% was associated with a greater hazard of the outcome independent of admission log B-type natriuretic peptide (adjusted hazard ratio = 6.8; 95% confidence interval 2.4–19.0; P <.001). Conclusions: Posthospitalization IVCCI assessment with PCUS predicts HF rehospitalization and may identify patients in need of intervention.

KW - Inferior vena cava

KW - heart failure

KW - pocket-carried ultrasound

KW - rehospitalization

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