Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point-of-Care Method to Predict Acute Decompensated Heart Failure 30-Day Readmission
| Autor: | Jared D. Romeo, Rick G. Schnatz, John J. Pacella, Marc A. Simon |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure Cost effectiveness Point-of-Care Systems 030204 cardiovascular system & hematology Patient Readmission 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Intravascular volume status Humans 030212 general & internal medicine Point of care Aged Ultrasonography Original Research Heart Failure Receiver operating characteristic cost effectiveness business.industry ultrasound Ultrasound Central venous pressure Middle Aged medicine.disease Prognosis 3. Good health Heart failure Acute Disease Cardiology Female sense organs Cost-Effectiveness Jugular Veins Cardiology and Cardiovascular Medicine business Compliance |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| Popis: | Background Heart failure is one of the most costly diagnosis‐related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross‐sectional area ( CSA ) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure. Methods and Results Patients admitted with acute decompensated heart failure ( ADHF ) underwent ultrasound measurements of the right internal jugular vein at end‐expiration and during the strain phase of Valsalva to determine a percentage of CSA change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of CSA change predictive of right atrial pressure ( RAP ) ≥12 mm Hg. Images of admitted ADHF patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a CSA change predicted RAP ≥12 mm Hg (positive predictive value: 87%; P RAP by percentage of CSA change normalized by discharge ( P CSA change, normal RAP at discharge had 91% predictive value for patients avoiding 30‐day readmission ( P Conclusions This bedside ultrasound technique strongly correlates to invasive RAP measurement in ADHF patients, identifies restoration of euvolemia, and is predictive of 30‐day ADHF readmission. This tool could help guide inpatient ADHF treatment and may lead to reduced readmissions. |
| Databáze: | OpenAIRE |
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