The role of point-of-care ultrasound protocols in predicting clinical outcomes, readmission, and mortality in patients presenting to the emergency department with acute heart failure

AIM: This study aimed to evaluate the effectiveness of point-of-care ultrasound (POCUS) protocols, performed at admission and after treatment, in predicting clinical outcomes, 30-day readmission, and 30-day mortality among patients presenting to the emergency department with acute heart failure (AHF). METHODS: The study was conducted with 128 volunteer participants utilizing a prospective observational design. POCUS examinations were performed at emergency department admission and again three hours after treatment initiation. The protocol included left ventricular ejection fraction (LVEF) assessment, inferior vena cava (IVC) and internal jugular vein (IJV) measurements, and application of the BLUE lung ultrasound protocol. The primary endpoint was 30-day mortality. RESULTS: The median age of the patients was 75.5 years, and 52.3% were male. While 50.8% of the patients were admitted to the hospital, the overall 30-day mortality rate was 12.5%. Although admission LVEF values did not differ significantly between discharged and hospitalized patients, both admission and post-treatment IVC and IJV diameters were larger in hospitalized patients. These patients also exhibited lower IVC collapsibility indices and IJVmaks/min ratios, as well as higher numbers of lung B-lines and greater pleural effusion. The differences observed in IVC and IJV measurements post-treatment among patients who presented for re-admission within thirty days did not establish either parameter as an independent predictor. Conversely, high IVC and IJV diameters, low IVC collapsibility and IJVmaks/min ratios, and increased numbers of lung B-lines and pleural effusion observed in both admission and post-treatment POCUS assessments were associated with 30-day mortality. Among all parameters, the post-treatment IJVmin value was identified as the strongest predictor of mortality. CONCLUSION: In patients presenting to the emergency department with acute heart failure, POCUS performed at admission and after treatment can be utilized to assess systemic and pulmonary congestion, monitor treatment response, support hospitalization decisions, and predict mortality. However, since our study is among the limited number of investigations comparing admission and post-treatment measurements, further studies with larger sample sizes are required to validate these findings. Keywords: Acute heart failure, emergency, ultrasound, mortality