Abstract 11609: Point of Care Lung Ultrasound Predicts Heart Failure Readmissions

Introduction:Readmissions after hospitalization for acute decompensated heart failure (ADHF) are common with nearly 25% of patients readmitted within 30 days of discharge. Lung ultrasound (LUS) is a validated diagnostic tool to evaluate pulmonary congestion that has potential for identifying higher risk patients at the time of discharge.Hypothesis:Pulmonary congestion in patients with ADHF identified by LUS at the time of discharge predicts readmission within 30 days.Methods:Patients were enrolled at the time of discharge after hospitalization for ADHF, defined as a presentation with dyspnea, NT-pro-BNP ?400 pg/ml, and pulmonary congestion confirmed by physical exam and/or chest x-ray. An 8 quadrant LUS exam was performed using a phased array probe by trained investigators. Quadrants with ? 3 B-lines were designated as positive (+) and the total number of + quadrants assessed. 31 days post discharge the patients were contacted and medical records reviewed to determine hospital readmission.Results:Over 21 months, 151 patients were enrolled (73.2?12.4 years, 62% male) with an overall readmission rate of 26%. Higher admission NT-pro-BNP was associated with increased + LUS quadrants seen at discharge (p=0.0039). There was a marked rise in readmission rate with increasing number of + LUS quadrants seen on discharge (Figure). Using log-binomial regression analysis, with 0-1 + quadrants as reference, patients with 2-3+ or 4-7+ quadrants had a RR 2.38 (CI 1.05, 5.36; p<0.0001) and RR 8.13 (CI 4.6, 14.4; p<0.0001), respectively. In contrast, there was no association between weight loss during hospitalization and readmission.Conclusions:Discharge LUS demonstrating ? 2 + quadrants was a significant predictor of 30-day readmission in this cohort. Furthermore, ? 4 + quadrants identified a particularly high risk population. Further studies will clarify the role of discharge LUS in managing this population.