护士对心力衰竭患者的肺部和下腔静脉评估。
Nurse-Provided Lung and Inferior Vena Cava Assessment in Patients With Heart Failure.
机构信息
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The University of Melbourne, Baker Department of Cardiometabolic Health, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia; The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia.
Western Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia; Eastern Health, Melbourne, Victoria, Australia.
出版信息
J Am Coll Cardiol. 2022 Aug 2;80(5):513-523. doi: 10.1016/j.jacc.2022.04.064.
BACKGROUND
Residual congestion detected using handheld ultrasound may be associated with increased risk of readmission and death after hospitalization for acute decompensated heart failure (ADHF). However, effective application necessitates routine use by nonexperts delivering clinical care.
OBJECTIVES
The objective of this study was to determine the ability of heart failure (HF) nurses to deliver a predischarge lung and inferior vena cava (IVC) assessment (LUICA) to predict 90-day outcomes.
METHODS
In this multisite, prospective, observational study, HF nurses scanned 240 patients with ADHF (median age: 77 years; 56% men) using a 9-zone LUICA protocol. Obtained images were reviewed by independent nurses who were blinded to clinical characteristics and outcomes. Based on a B-line cut-off of 10, patients were dichotomized as congested (n = 115) or not congested (n = 125).
RESULTS
Congested patients were more likely to have previous cardiac operations, long-standing HF (>6 months), and renal impairment. At 90 days, HF readmission or mortality occurred in 42 congested patients (37%) compared with 18 noncongested patients (14%). Pulmonary congestion increased at 30-day (OR: 3.86; 95% CI: 1.65-8.99; P < 0.01) and 90-day (OR: 3.42; 95% CI: 1.82-6.4; P < 0.01) HF readmission or mortality risk and 90-day mortality (OR: 5.18; 95% CI: 1.44-18.69; P < 0.01). Pulmonary congestion increased the 90-day odds of HF readmission and/or death by 3.3- to 4.2-fold (P < 0.01), independent of demographics, HF characteristics, comorbidities, and event risk score. Over 90 days, days alive out of hospital were fewer (78.3 ± 21.4 days vs 85.5 ± 12.4 days; P < 0.01) in congested patients.
CONCLUSIONS
LUICA can be a powerful tool for detection of predischarge residual congestion. HF nurses can obtain images and provide diagnostic reports that are predictive of ADHF outcomes.
背景
使用手持式超声检测到的残余充血可能与急性失代偿性心力衰竭（ADHF）住院后再入院和死亡的风险增加有关。然而，为了有效应用，需要由提供临床护理的非专家进行常规使用。
目的
本研究的目的是确定心力衰竭（HF）护士进行出院前肺部和下腔静脉（IVC）评估（LUICA）的能力，以预测 90 天的结果。
方法
在这项多中心、前瞻性、观察性研究中，HF 护士使用 9 区 LUICA 方案对 240 名 ADHF 患者（中位年龄：77 岁；56%为男性）进行了扫描。获得的图像由独立的护士进行审查，这些护士对临床特征和结果一无所知。根据 B 线截断值为 10，将患者分为充血组（n=115）和不充血组（n=125）。
结果
充血患者更有可能接受过心脏手术、长期心力衰竭（>6 个月）和肾功能损害。在 90 天时，充血患者中有 42 例（37%）发生 HF 再入院或死亡，而非充血患者中有 18 例（14%）。在 30 天（OR：3.86；95%CI：1.65-8.99；P<0.01）和 90 天（OR：3.42；95%CI：1.82-6.4；P<0.01）HF 再入院或死亡率风险和 90 天死亡率（OR：5.18；95%CI：1.44-18.69；P<0.01）时，肺部充血增加。肺部充血使 90 天 HF 再入院和/或死亡的可能性增加了 3.3-4.2 倍（P<0.01），独立于人口统计学、HF 特征、合并症和事件风险评分。在 90 天以上的时间里，充血患者出院后存活的天数更少（78.3±21.4 天 vs 85.5±12.4 天；P<0.01）。
结论
LUICA 可以成为检测出院前残余充血的有力工具。HF 护士可以获取图像并提供具有 ADHF 结果预测能力的诊断报告。
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