Document Detail

Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure.
MedLine Citation:
PMID:  19356487     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to compare the value of serial assessment with hand-carried ultrasound (HCU) of the inferior vena cava (IVC) with brain natriuretic peptide (BNP) to identify patients with acute decompensated heart failure (ADHF) who will be readmitted or seek emergency department treatment after hospital discharge. BACKGROUND: Congestive heart failure (CHF) is a leading cause for hospitalization and, once hospitalized, patients with CHF frequently are readmitted. To date, no reliable index exists that can be used to predict whether patients with ADHF can be discharged with low readmission likelihood. METHODS: A total of 75 patients who were admitted with a primary diagnosis of ADHF were followed. All patients were assessed at admission and discharge with the use of routine clinical evaluation, BNP measurement, and HCU evaluation of the IVC by physicians with limited training in ultrasound. RESULTS: During the 30-day follow-up, 31 patients were rehospitalized or presented to the emergency department. Patients who were subsequently readmitted could not be differentiated from those who were not readmitted by their demographics, comorbidities, vital signs, presence of symptoms/signs suggestive of persistent congestion, hospital length of stay, or net volume removal. Routine laboratory tests, including assessment of renal function, also failed to predict readmission with the exception of serum sodium. Although admission BNP was similar in patients readmitted and not readmitted, pre-discharge log-transformed BNP was greater in patients who subsequently were readmitted. Patients who required repeat hospitalization had a larger IVC size on admission as well as at discharge. In addition, patients who were readmitted had persistently plethoric IVCs with lower IVC collapsibility indexes. At discharge, only serum sodium, log-transformed BNP, IVC size, and collapsibility were statistically significant predictors of readmission. CONCLUSIONS: This study confirms that, once hospitalized, patients with CHF frequently are readmitted. Bedside evaluation of the IVC with a HCU device at the time of admission and discharge, as well as pre-discharge BNP, identified patients admitted with ADHF who were more likely to be readmitted to the hospital.
Sascha N Goonewardena; Anthony Gemignani; Adam Ronan; Samip Vasaiwala; John Blair; J Matthew Brennan; Dipak P Shah; Kirk T Spencer
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  1     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-04-23     Revised Date:  2009-05-21    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  595-601     Citation Subset:  IM    
University of Chicago Hospitals, Chicago, Illinois 60637, USA.
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MeSH Terms
Acute Disease
Biological Markers / blood
Equipment Design
Heart Failure / blood,  diagnosis*,  therapy,  ultrasonography
Logistic Models
Middle Aged
Natriuretic Peptide, Brain / blood*
Odds Ratio
Patient Readmission*
Peptide Fragments / blood*
Point-of-Care Systems*
Predictive Value of Tests
Prospective Studies
Risk Assessment
Time Factors
Treatment Outcome
Ultrasonography / instrumentation
Vena Cava, Inferior / ultrasonography*
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain
Comment In:
JACC Cardiovasc Imaging. 2008 Sep;1(5):602-4   [PMID:  19356488 ]

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