None listed
Conditions
Brief summary
This study aims to improve the management of patients admitted to the Hospital in the Home (HITH) program with heart failure by integrating lung ultrasound into clinical assessment and treatment decisions. Lung ultrasound is more accurate than physical examination or chest X-ray in detecting pulmonary congestion, which means detecting fluid in the lung that is often missed using conventional methods. Studies have shown that incorporating lung ultrasound significantly improves fluid detection, leading to better-guided therapy. To generate the necessary evidence for implementing this technique, this study will compare standard heart failure management with an approach that incorporates lung ultrasound. A total of 110 participants will be enrolled, with half receiving lung ultrasound and the other half following usual care. Key outcomes, including hospital readmission rates, length of stay in the HITH program, and medication adjustments, will be assessed and compared between groups. This research will provide valuable data on the potential benefits of lung ultrasound in optimising heart failure treatment in home-based care settings.
Interventions
The intervention consists of a focused lung ultrasound performed as an adjunct to the standard clinical assessment. Lung ultrasound is a bedside examination conducted by a clinician trained in lung ultrasound, with the aim of identifying findings relevant to decompensated heart failure, including pulmonary oedema and pleural effusions.
There are no restrictions on the type of ultrasound equipment used; examinations may be performed using either a portable ultrasound machine or a handheld ultraso
The intervention consists of a focused lung ultrasound performed as an adjunct to the standard clinical assessment. Lung ultrasound is a bedside examination conducted by a clinician trained in lung ultrasound, with the aim of identifying findings relevant to decompensated heart failure, including pulmonary oedema and pleural effusions. There are no restrictions on the type of ultrasound equipment used; examinations may be performed using either a portable ultrasound machine or a handheld ultrasound device. The procedure involves the application of ultrasound gel to the patient's skin and the gentle placement of an ultrasound transducer over predefined anterior and posterior chest zones. The examination is non-invasive, does not involve ionising radiation, and typically takes 5–10 minutes to complete. The initial lung ultrasound is performed during the first clinical assessment by the Hospital in the Home (HITH) medical team. Follow-up scans may be performed on up to three additional occasions in conjunction with routine clinical reassessments, with the final ultrasound occurring no later than 30 days after enrolment. Adherence to the intervention will be assessed through review of HITH medical records and direct communication with the HITH clinicians involved in patient care, including telephone calls and secure work-based messaging systems.
Sponsors
Melbourne Health
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult 18 years or older admitted to the hospital in the home program with the main diagnosis of decompensated heart failure. The diagnosis of decompensated heart failure will be done by HITH clinicians and not by the researcher team. The definition of heart failure use in this trial is based on the 2016 ESC guidelines." along with the complete name for ESC and re-enter the text "using a combination of typical symptoms (e.g., breathlessness, ankle swelling, fatigue) and physical signs (e.g., elevated jugular venous pressure, pulmonary crackles, peripheral oedema), consistent with a structural and/or functional cardiac abnormality leading to reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. When available, a BNP level >400 pg/mL will be used to support the diagnosis. This study includes both type of heart failure: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)."
Exclusion criteria
- Patients who have undergone a lung ultrasound or chest CT within the past 24 hours, - Patients with known diagnosis of chronic interstitial lung disease (ILD) such as idiopathic pulmonary fibrosis as the lung ultrasound findings associated with ILD may be misinterpreted as acute pulmonary oedema.
Outcome results
None listed