Abstract

Aims: Pre-discharge pulmonary congestion after heart failure hospitalisation (HFH), detected by lung ultrasound (LUS), predicts worse outcomes.We aimed to characterise pre-discharge congestion using LUS as compared with clinical volume assessment in a general medicine inpatient cohort.Associations with post-discharge care were evaluated. Methods:We enrolled patients with HF from the general medicine ward, and evaluated pre-discharge clinical volume status using a modified congestion score evaluating jugular venous distension, rales and peripheral oedema.Concomitant LUS using the Philips Lumify probe (Philips, Cambridge, USA) was conducted using an 8-sector scanning protocol, and 10 b-lines defined prognostically significant lung congestion.Clinical and referral data were extracted from the electronic medical record.Results: 66 patients (52% female, median age 85 (77-91) years) were enrolled.Common causes of HF decompensation were pulmonary infections (24%), arrhythmia (20%) and non-adherence to self-management (14%).The average dose increase of frusemide from pre-admission was 36 (0-40) mg and 42 (64%) patients were clinically euvolaemic predischarge.40 (61%) patients were referred for intensive post discharge HF care.On LUS, the mean number of b-lines was 12 8. Clinical euvolaemia was associated with fewer b-lines compared with hypervolaemia (10 8 vs. 16 7, p = 0.006).20 (47%) clinically euvolaemic patients had 10 b-lines compared with 18 (75%) clinically hypervolaemic patients.In univariate analysis age was associated with reduced likelihood of referral for post-discharge HF care (OR 0.94, 95% CI 0.87-0.99,p = 0.035) but comorbidities, furosemide dose, natriuretic peptide, serum creatinine or presence of clinical congestion were not.Adjusting for age, clinical hypervolaemia was not associated with referral for post-discharge HF care (OR 1.31, 95% CI 0.43-3.96,p = 0.63).Conclusions: Nearly half of clinically euvolaemic patients exhibit subclinical pulmonary congestion on discharge.Clinical hypervolaemia on discharge appears unrelated to decisions on referral for intensive postdischarge HF care.