Nurse-led lung ultrasound for congestion assessment in a heart failure clinic: impact on clinical decision-making and patient management

Background

Heart failure (HF) nurses play a pivotal role in the ongoing assessment and management of congestion. Clinical examination alone often underestimates pulmonary congestion, leading to delayed or suboptimal treatment. Lung ultrasound (LUS) is a rapid, non-invasive bedside tool increasingly used by non-physician clinicians (Gargani et al. 2023), but evidence supporting nurse-led LUS in routine HF care remains limited.

Purpose

To evaluate the feasibility, diagnostic yield, and clinical impact of nurse-performed lung ultrasound in the assessment and management of congestion in a real-world heart failure clinic.

Methods

This prospective observational study included consecutive HF clinic visits where HF advanced nurse practitioner (ANP) performed point-of-care LUS between July 2024 and December 2025. LUS findings were categorised as bilateral B-lines, unilateral B-lines, pleural effusions, or no congestion. Clinical assessment, including chest auscultation, oedema and jugular venous pressure, was recorded. Changes in HF management following LUS were documented, including adjustment of diuretics and optimisation of guideline-directed medical therapy (GDMT).

Results

A total of 141 ANP performed LUS assessments were completed. Objective pulmonary congestion was detected in approximately 70% of scans, most commonly bilateral B-lines or pleural effusions. Importantly, congestion was frequently present despite clear chest auscultation and non-elevated jugular venous pressure, demonstrating significant discordance with clinical examination.

LUS directly influenced management in over 60% of clinic encounters. Loop diuretics were intensified in approximately 55–60% of patients and safely reduced in 15–20% following confirmation of decongestion. Initiation or optimisation of GDMT, including SGLT2 inhibitors, MRAs, and ARNI therapy, occurred in a substantial proportion of visits.

Conclusions

Nurse-led lung ultrasound is a feasible and impactful tool in the outpatient management of heart failure. By identifying clinically occult congestion and guiding timely therapy adjustments, LUS enhances the role of HF nurses in delivering precision, patient-centred care. Wider adoption of nurse-performed LUS may improve congestion management and optimise HF outcomes.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.