Everest clinical congestion score vs. Lung ultrasound for pre-discharge risk stratification in acute heart failure
F H Valicelli, S C Hermann, A D R Dias, F S Coneglian, D M Tanaka, H T Moreira, M V SimoesAbstract
Background
Clinical tools such as the Everest Clinical Congestion Score (ECC) and lung ultrasound (LUS) can be used to assess residual congestion and stratify the prognosis before hospital discharge inpatients with acute decompensated heart failure (ADHF).
Objective
We aimed at evaluating findings of residual congestion using LUS and ECC in pre-hospital discharge (PHD) patients with ADHF and correlate these findings with the occurrence of significant clinical events in the vulnerable phase (90 days after hospital discharge).
Materials and Methods
We investigated 100 consecutive patients hospitalized for ADHF, mean age 58.2±13.7 years, 54% male, left ventricular ejection fraction (LVEF) 27.9±13.3 %, length of stay 11.2±5.6 days, evaluated in the PHD with: 1. ECC, considered positive if edema, orthopnea, or jugular venous distension were present; 2. LUS, evaluating 8 lung fields for detection of B-lines (BL), considered positive for congestion if ≥ 1 lung field showed ≥ 3 BL. Serum NT-ProBNP and creatinine levels were also assessed. Clinical outcomes of intravenous furosemide use (IVF), rehospitalization for heart failure (REHF), and death from any cause were monitored in the 90 days after hospital discharge. Univariate and multivariate Cox regression analysis was used to test the correlation between the results of the investigated variables and clinical outcomes.
Results
The ECC in PHD was positive in 39 (39%) of patients, with detection of jugular venous distension in 30%, orthopnea in 11%, and edema in 4%. The LUS was positive in 30% of patients. The total number of BL was 84, and 23% of patients presented a total of > 7 B lines. There were 26 events in the vulnerable phase, including 16 (16%) IVF, 23 (23%) combined heart failure events (IVF or REHF), and 7 (7%) deaths. Table 1 presents the univariate regression analysis of the correlation between the biomarkers, ECC and LUS, with the outcomes. Table 2 presents the multivariate regression analysis including the variables that showed a positive univariate correlation.
Conclusion
Our results indicate that residual congestion is found in approximately 1/3 of patients in PHD due to ADHF and that ECC is effective in identifying clinically significant congestion associated with a higher risk of heart failure events after discharge, alongside the biomarkers.