Abstract 18320: Bedside Ultrasound Evaluation of Right Atrial Pressure to Predict Acute Decompensated Heart Failure 30-Day Readmission
Heart failure is one of the most costly diagnosis-related groups (DRG) in the U.S. with hospitalizations accounting for 60% of the total DRG cost. A large part of the morbidity and cost of heart failure are hospital readmissions. Due to this and recent health care laws penalizing hospitals for high readmission rates, there is a strong need for intervention. Objective assessment of volume status to ensure optimization prior to hospital discharge could significantly reduce readmissions. We have previously demonstrated a bedside ultrasound (US) method quantifying percent cross sectional area (CSA) change of the right internal jugular vein (RIJV) with Valsalva that reliably estimates central venous pressure. We hypothesize that bedside US measurement of the RIJV in acute decompensated heart failure (ADHF) patients at discharge is predictive of 30-day readmission. Patients admitted with ADHF to the heart failure service were enrolled. A portable US machine (Sonosite iLook25) equipped with a standard broadband linear array (10-5MHz) transducer was used to image the RIJV at end-expiration and during the strain phase of Valsalva. Valsalva was standardized by a manometric pressure of at least 40 mmHg during expiration against a closed glottis. Images were obtained at admission and discharge (n=157). A subgroup of patients underwent RHC with accompanying US measurements of the RIJV (n=76) demonstrating that a percent cross sectional area (CSA) change of <66% predicted a RAP ≥12mmHg (positive predictive value 87%, p < 0.05 ROC). Elevated admission RAP by percent CSA change normalized by discharge (p < 0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the 66% CSA change cutoff, a normal RAP at discharge had a 91% predictive value for patients avoiding 30-day readmission (p < 0.05). This bedside US technique strongly correlates to invasive RAP measurement in ADHF patients identifying 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.
Author Disclosures: F.G. Schnatz: None. S.N. Parikh: None. J.E. Leeman: None. M. Singh: None. F.S. Villanueva: None. M.A. Simon: None. J.J. Pacella: None.
- © 2014 by American Heart Association, Inc.