Effect of Handheld Echocardiography by Trained Advanced Practice Providers on Heart Failure Management and Readmissions.

OBJECTIVE

To evaluate the effect of point-of-care ultrasound using handheld echocardiography (HHE) by trained advanced practice providers (APPs) on congestive heart failure (CHF) readmissions.

PATIENTS AND

METHODS

This prospective cohort study comprised 140 consecutive patients with CHF admitted under cardiology service and involved an intervention group (n=67), in whom APPs trained in HHE assessed left ventricular ejection fraction and right atrial pressure (RAP) using HHE, and a control group (n=73) identified retrospectively during concurrent period, who received standard APP-delivered care without HHE. Advanced practice providers incorporated HHE findings into guideline-directed medical therapy (GDMT) decisions. Clinical characteristics, GDMT, length of stay, and 30-day all-cause and CHF readmissions were evaluated.

RESULTS

Baseline demographic characteristics and medical therapy were similar except higher diabetes incidence in the HHE group (59.70% vs 32.88%; P<.01) and higher stroke (26.03% vs 10.45%; P<.05) and heart rate incidence (88±22 vs 80±15 bpm; P<.05) in the control group. Predischarge RAP on HHE was lower from admission in the study group. Considerable increases in GDMT prescription rates from admission to discharge occurred in both groups, but with no significant differences at discharge. Thirty-day CHF readmissions were lower in the HHE group (4.5% [95% CI, 0.9%-12.5%] vs 12.3% [95% CI, 5.7%-22.1%]; P<.05). Length of stay and 30-day all-cause readmissions were similar n both groups.

CONCLUSION

In patients hospitalized with CHF, the addition of HHE-guided assessment by APPs was associated with lower predischarge RAP and reduced 30-day readmissions for CHF exacerbations. These hypothesis generating findings require validation in larger randomized trials.