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Inicio Medicina Clínica (English Edition) Impact of clinical ultrasound in patients with heart failure treated in home
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Vol. 159. Issue 9.
Pages 420-425 (November 2022)
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Vol. 159. Issue 9.
Pages 420-425 (November 2022)
Original article
Impact of clinical ultrasound in patients with heart failure treated in home
Impacto de la ecografía clínica en pacientes con insuficiencia cardíaca atendidos en hospitalización a domicilio
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Lara Palacios Garcíaa, Mónica Enguita Germánb, Pablo Ruiz Sadaa,
Corresponding author
pablo.ruiz.sada@navarra.es

Corresponding author.
, Aitziber Echeverría Echeverríaa, María González Gómezc, María Teresa Rubio Obanosa
a FEA, adjunto del Servicio de Medicina Interna, Hospital Reina Sofía de Tudela, Tudela, Navarra, Spain
b Navarrabiomed-Hospital Universitario de Navarra (HUN)-UPNA, Pamplona, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Navarra, Spain
c FEA, Adjunto del Servicio de Medicina Interna, Hospital de Mérida, Mérida, Badajoz, Spain
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Abstract
Background and objective

In Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC).

Patients and methods

A randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the “UG-ultrasound group” (SC and CU performed) and the “CG-control group” (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF.

Results

A total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1–1) and mortality by 30% (RR 0.7; 95% CI: 0.2–2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power.

Conclusion

Our results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.

Keywords:
RCT
Acute heart failure
Hospitalization at home
Ultrasound
Mortality
Resumen
Antecedentes y objetivo

En España, más del 10% de pacientes con insuficiencia cardíaca aguda (ICA) dados de alta son reingresados en los primeros 30 días. Se diseña este trabajo para valorar si el tratamiento de ICA guiado por ecografía clínica (EC) en el ámbito de hospitalización a domicilio (HAD) reduce la incidencia de reingreso y mortalidad respecto al abordaje estándar (AE).

Pacientes y métodos

Se diseñó un ensayo clínico aleatorizado (ECA), abierto, paralelo, unicéntrico y controlado (NT05042752). Se incluyeron de forma consecutiva a pacientes >18 años ingresados por ICA en HAD desde enero de 2021 a abril 2021 en el Hospital Reina Sofía de Tudela. Los pacientes se aleatorizaron a “grupo ecografía-GE” (realización de AE y EC) y “grupo control-GC” (AE). El tratamiento diurético fue modificado según los hallazgos del AE junto con la EC o según los hallazgos del AE respectivamente. Las variables principales fueron el riesgo relativo de reingreso y mortalidad por ICA.

Resultados

Un total de 79 pacientes fueron aleatorizados, 39 a GE y 40 a GC. De ellos, solo completaron la intervención 35 del GC y 35 del GE. El riesgo de reingreso por ICA se redujo un 60% en el GE respecto del GC (RR 0,4; IC 95%: 0,1–1) y el de mortalidad en un 30% (RR 0,7; IC 95%: 0,2–2,2). A pesar de la relevante magnitud del efecto encontrado, los resultados no alcanzan la significación estadística por falta de potencia.

Conclusión

Nuestros resultados sugieren que en HAD, el tratamiento de ICA guiado por EC podría reducir el riesgo de reingreso y mortalidad respecto al AE, aunque hacen falta estudios, con mayor potencia estadística, que confirmen estos resultados.

Palabras clave:
ECA
Insuficiencia cardíaca aguda
Hospitalización a domicilio
Ecografía
Mortalidad

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