VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated Heart Failure: A Cohort Study

Rinaldi, Paulo Maciel; Rihl, Marcos Frata; Boniatti, Márcio Manozzo

doi:10.36660/abc.20230745

Brasil

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Original Article • Arq. Bras. Cardiol. 121 (5) • 2024 • https://doi.org/10.36660/abc.20230745i linkcopy

VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated Heart Failure: A Cohort Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Central Illustration
: VExUS Score at Discharge as a Predictor of Readmission in Patients with Acute Decompensated Heart Failure: A Cohort Study

ADHF: acute decompensated heart failure; NYHA: New York Heart Association; VExUS: venous excess ultrasound score.

Abstract

Background Residual venous congestion is a major contributor to readmission of patients with heart failure, and the venous excess ultrasound (VExUS) score is a potentially useful tool to evaluate systemic congestion.

Objectives To investigate the association between VExUS score before hospital discharge among patients with heart failure and the risk of readmission due to acute decompensated heart failure (ADHF) within 90 days after discharge.

Methods This prospective cohort study enrolled adults with signs and symptoms of ADHF, left ventricular ejection fraction of 40% or below (heart failure with reduced ejection fraction), New York Heart Association functional class II to IV symptoms, and clinical evidence of venous congestion necessitating intravenous diuretics. Just prior to discharge, we conducted VExUS score evaluation. The primary outcome was a composite endpoint of readmission or emergency visits due to ADHF within 90 days following hospital discharge. Statistical significance was set at p < 0.05.

Results The cohort comprised 49 individuals, 11 (22.4%) of whom experienced the primary outcome. At discharge, 34.7% of participants had VExUS score 2 or 3. Patients with VExUS 2 and 3 had a higher proportion of the primary outcome when compared with patients with VExUS of 0 (35.3% versus 9%, p = 0.044).

Conclusions A significant proportion of patients with heart failure with reduced ejection fraction admitted for ADHF presented clinical and ultrasound signs of residual congestion at discharge. Patients with VExUS score of 2 or 3 at the time of hospital discharge were found to be at higher risk of readmissions or emergency visits due to ADHF after 90 days.

Keywords Heart Failure; Patient Readmission; Quality of Life

Variables	All patients (n=49)	Without primary outcome (n=38)	With primary outcome (n=11)	p
Variables	n (%)*	n (%)*	n (%)*	p
Age, years^†	59.5 (47.3 - 69.0)	56.0 (46.5 - 70.0)	64.0 (57.0 - 69.0)	0.259
Male sex	35 (71.4)	25 (65.8)	10 (90.9)	0.104
Preexisting conditions
Hypertension	32 (65.3)	23 (60.5)	9 (81.8)	0.191
Diabetes	15 (30.6)	10 (26.3)	5 (45.5)	0.225
Ischemic cardiomyopathy	21 (42.9)	16 (42.1)	5 (45.5)	0.843
Atrial fibrillation	14 (28.6)	12 (31.6)	2 (18.2)	0.386
CKD	4 (8.2)	2 (5.3)	2 (18.2)	0.168
COPD	7 (14.3)	6 (15.8)	1 (9.1)	0.576
Admission for ADHF in the last 12 months	16 (32.7)	10 (26.3)	6 (54.5)	0.079
NYHA functional classification				0.439
II	5 (10.2)	3 (7.9)	2 (18.2)
III	15 (30.6)	13 (34.2)	2 (18.2)
IV	29 (59.2)	22 (57.9)	7 (63.6)
Baseline medications
Beta blocker	36 (73.5)	26 (68.4)	10 (90.9)	0.137
CE inhibitor/ARB	36 (73.5)	27 (71.1)	9 (81.8)	0.476
Mineralocorticoid antagonist	22 (44.9)	15 (39.5)	7 (63.6)	0.156
ARNi	3 (6.1)	3 (7.9)	-	0.336
Nitrate	8 (16.3)	6 (15.2)	2 (18.2)	0.850
SGLT2 inhibitor	4 (8.2)	4 (10.5)	-	0.261
Digitalis	9 (18.4)	4 (10.5)	5 (45.5)	0.008
Loop diuretic	37 (75.5)	28 (73.7)	9 (81.8)	0.581
Thiazide	2 (4.1)	-	2 (18.2)	0.047
Laboratory data at baseline
Hemoglobin (g/dL)^‡	13.4 ± 2.0	13.6 ± 2.0	12.8 ± 2.1	0.291
Creatinine (mg/dL)^†	1.2 (0.9-1.4)	1.1 (0.9-1.3)	1.3 (1.1-1.6)	0.122
Sodium (mmol/L)^†	139.0 (136.0-141.0)	140.0 (136.8-142.0)	136.0 (132.0-139.0)	0.018
Hospitalization data
Ejection fraction^‡	24.2 ± 6.4	24.3 ± 6.2	24.0 ± 7.0	0.896
Right ventricular dysfunction	27 (55.1)	21 (55.3)	6 (54.5)	0.966
Noninvasive ventilation	6 (12.2)	6 (15.8)	-	0.159
Intravenous vasodilator	15 (30.6)	11 (28.9)	4 (36.4)	0.638
Inotrope use	5 (10.2)	3 (7.9)	2 (18.2)	0.321
Hospital LOS (days)^†	15.0 (9.0-21.0)	14.5 (8.8-21.0)	15.0 (10.0-18.0)	0.548
Discharge medications
Beta blocker	47 (95.9)	37 (97.4)	10 (90.9)	0.340
ACE inhibitor/ARB	34 (69.4)	28 (73.7)	6 (54.5)	0.225
Mineralocorticoid antagonist	39 (79.6)	28 (73.7)	11 (100.0)	0.057
ARNi	7 (14.3)	5 (13.2)	2 (18.2)	0.675
Nitrate	13 (26.5)	10 (26.3)	3 (27.3)	0.950
SGLT2 inhibitor	10 (20.4)	8 (21.1)	2 (18.2)	0.835
Digitalis	19 (38.8)	15 (39.5)	4 (36.4)	0.852
Loop diuretic	46 (93.9)	35 (92.1)	11 (100.0)	0.336
Thiazide	10 (20.4)	5 (13.2)	5 (45.5)	0.019
Vital signs at discharge
Systolic blood pressure^†	109.0 (94.5-119.0)	109.5 (94.8-118.5)	105.0 (93.0-120.0)	0.914
Heart rate^‡	72.4 ± 12.9	74.1 ± 13.6	66.5 ± 8.0	0.027
Laboratory findings at discharge
Creatinine (mg/dL)^†	1.1 (1.0-1.6)	1.1 (1.0 - 1.3)	1.6 (1.1-2.1)	0.028
Sodium (mmol/L)^†	138.0 (134.0-139.0)	138.0 (135.8-139.0)	134.0 (133.0-138.0)	0.047

Variable	All patients (n=49)	Without primary outcome (n=38)	With primary outcome (n=11)	p
Variable	n (%)*	n (%)*	n (%)*	p
EVEREST score^†	2.0 (1.0 - 3.0)	1.5 (1.0 - 3.0)	2.0 (1.0 - 3.0)	0.759
EVEREST score ≥ 2	26 (53.1)	19 (50.0)	7 (63.6)	0.425
Number of positive quadrants on the LUS				0.692
0-1	30 (61.2)	24 (63.2)	6 (54.5)
2-3	13 (26.5)	9 (23.7)	4 (36.4)
4-8	6 (12.2)	5 (13.2)	1 (9.1)
VExUS score
0	22 (44.9)	20 (52.6)	2 (18.2)
1	10 (20.4)	7 (18.4)	3 (27.3)	0.131^‡
2 or 3	17 (34.7)	11 (28.9)	6 (54.5)	0.044^‡

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[TFN1001] ACE: angiotensin-converting enzyme; ADHF: acute decompensated heart failure; ARB: angiotensin II receptor blocker; ARNi: angiotensin receptor-neprilysin inhibitor; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; LOS: length of stay; NYHA: New York Heart Association; SGLT2: sodium-glucose co-transporter-2. * Unless otherwise stated. ^† Values are expressed as the median (interquartile range). ^‡ Values are expressed as the mean ± standard deviation.