Accuracy of early bedside echo for the rapid diagnosis of heart failure in dyspnoeic patients

We aim to undertake early bedside echo - also known as Point of Care Ultra Sound [POCUS] - in consecutively admitted patients with dyspnoea within 24 hours of their presentation to the Emergency Department. The Sonosite Edge II portable ultrasound [about 7 years old] which is carried in an over-shoulder bag and therefore can be moved around wards easily. In the Emergency Dept we use a trolley-based Sonosite device of similar vintage. We are hoping to replace our Sonosites later this year with a Mindray MX5 compact ultrasound system which gives similar quality pictures. Patients will be informed about the study and asked to provide consent. Patients will then be divided into 2 groups whereby patients are given a study number [in order of presentation] and then randomly allotted into: group 1 in whom bedside echo is undertaken immediately and the echo results are shared with the medical team, and group 2, in whom no immediate bedside echo is done and the medical management is based only on standard criteria for volume overload/heart failure. Each bedside echo consists of imaging the heart, inferior vena cava, and the lungs, all of which takes 10 minutes. Images will be stored on our PAX system for later reference. Echoes will be done, or directly supervised by, the principle investigators David Jardine and Jacques Loubser. A data sheet will be filled out by the investigator detailing important results including speed of recovery, length of stay, and echo results. During the admission “recovery indices” will be recorded by the medical teams and later assessed by an investigator blinded to the bedside echo results. The final diagnosis relating to the cause of dyspnoea [volume overload or something else] will be made by the medical teams caring for the patient at time of discharge. Depending on these results, the medical team caring for the patient will document a working diagnosis of volume overload [or otherwise] within 24 hours of admission. Subsequent investigations and treatment will be undertaken as indicated in both groups. Patients presenting with dyspnoea may require further relevant imaging, particularly if they do not respond to treatment [eg diuretics, antibiotics, anticoagulation]. These investigations might include formal echo, repeat chest X-ray, CT chest, and further blood tests. It may be that patients in the control arm require more investigations during their stay so this is important data.