Acute Decompensated Heart Failure
Conditions
Keywords
Point of care ultrasound, Focused cardiac ultrasound, heart failure, inferior vena cava, POCUS, CHF, FCU, acute heart failure, decompensated heart failure
Brief summary
This study evaluates daily POCUS/FCU exams on patients admitted for acute decompensated heart failure with primary end point of acute kidney injury while in hospital.
Detailed description
Patients with admitted to hospital with Acute Decompensated Heart failure (ADHF) suffer a significant morbidity and premature mortality. Administration of intravenous (IV) diuretics is largely guided by clinical judgment based on physical exam, net fluid measurement, changes in daily weights and chest x-ray findings. The key objective is to promote adequate diuresis while improving symptoms, without compromising renal function. Laboratory tests demonstrating hemo-concentration, increasing BUN, and increasing creatinine have been proposed as positive prognostic indicators in patients receiving IV diuretic therapy but these methods suffer from inadequate predictive value. Observational studies have identified worsening renal failure (WRF) in patients admitted for heart failure as an important clinical entity associated with worsening clinical outcomes. Point of care Ultrasound (POCUS) has the potential to fill an unmet need for monitoring patients recieving IV diuretic therapy. POCUS provides clinicians with immediate diagnostic information obtained and interpreted at bedside that can augment and enhance the physical examination. Numerous studies have examined POCUS assessment of pulmonary edema and measurement of the Inferior Vena Cava (IVC) to estimate hemodynamic parameters for patients with acute decompensated heart failure (ADHF). No study to date has examined POCUS effect on clinical outcomes.
Interventions
DIAGNOSTIC_TESTDaily pocus exam
Daily evaluation of lung ultrasound for B line artifacts plus IVC assessments
Sponsors
Riverside University Health System Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized open label controlled trial
Eligibility
Sex/Gender
ALL
Age
18 Years to 95 Years
Healthy volunteers
No
Inclusion criteria
* Age \>18 admitted for acute decompensated heart failure exacerbation as primary admission diagnosis from Emergency department to General Medicine ward that are administered diuretic therapy expected to be admitted for two days or more.
Exclusion criteria
1. Decline consent for study 2. If admitted and research team not available for consent and initial evaluation prior within 6 hours of first diuretic administration 3. Patients in whom diuretics will not be utilized (i.e. anuric, ESRD on HD) 4. Inability to assess IVC (surgical anatomy, body habitus, Ileus, etc.) 5. Patients admitted to ICU 6. Patients currently on positive pressure ventilation (BiPAP) 7. Patients discharged from the emergency department 8. Patients discharged prior to evaluation by the POCUS team
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Worsening renal failure | During hospitalization typically one week | Serum Creatnine levels measured in mg/dL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of stay | During hospitalization typically one week | Measured in days from initial admission to discharge |
Countries
United States
Contacts
Primary ContactMichael Ulrich, MD
Backup ContactMinho Yu, DO
Outcome results
None listed