Home-operated ultrasound exam for detection of worsening heart failure (HOUSE-HF)

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Stuart B. Prenner, Kevin Dougherty, Frances S. Shofer, Lee R. Goldberg, Nova Panebianco
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引用次数: 0

Abstract

Aims

Acute decompensated heart failure (ADHF) is associated with a high degree of morbidity and mortality. Dynamic lung ultrasound artefact called B-lines can be obtained at the bedside and directly correlate with pulmonary vascular congestion. Obtaining patient-performed lung ultrasound images in the outpatient setting is novel. We assessed the feasibility of patients recently hospitalized for ADHF to self-perform a limited lung ultrasound using a handheld ultrasound probe and upload the images to a secure cloud for physician interpretation.

Methods

This was a prospective observational convenience sample. Patients were enrolled from an urban academic tertiary care centre and were eligible if they had chronic left-sided heart failure regardless of ejection fraction. While hospitalized, patients were educated for 20 min on a six-lung-zone image protocol, how to use the cloud archival system and given a handheld ultrasound transducer and smart tablet. A brief instructional video was also available to patients on the smart tablet throughout the study (https://www.dropbox.com/scl/fi/bii7ovdcv21ps7yxyqsy1/120-21080-00-Rev-01-BNI-041-UPENN-IN-APP-TRAINING-VIDEO.mp4?rlkey=f5vu55xbnugdoz6jzyb8lv872&st=56es4qif&dl=0). Patients were asked to upload images three times weekly, for 3 weeks, for a total of nine studies. All images were reviewed and a B-line score was calculated for each lung zone, and a total B-line score for the entire exam. Additionally, patients completed a survey to assess the patient-centred experience.

Results

A total of 15 patients were enrolled, all of whom completed seven or more studies (10 patients completed all 9). Median patient age was 63 years (range: 28 –86 years), the majority were male (73%), white (60%) and average body mass index was 33 kg/m2. Of them,33.3% had an ejection fraction >50%, average hospital length of stay was 6.3 days. Of the 792 potential images, 788 were obtained (99.5%). Of these, a total of 637 scans were interpretable (80.8%). The right upper apical lung zone (zone 1R) was most often adequate for interpretation (96.2%), where left lower mid-axillary (zone 3L) was least often interpretable (69.5%). The average number of B-lines per six-image scan was three (with a range of 0–13). Patient survey data identified zone 3L as the most challenging to obtain with overall high satisfaction with the study educational materials.

Conclusions

This pilot study demonstrates that patients with hospitalized ADHF can be taught to use a handheld portable ultrasound device and obtain and upload high quality lung ultrasound images. Compliance with the study protocol and ability to obtain some images were excellent. Further studies are needed to determine if patient-performed lung ultrasound can help detect and manage acute worsening HF in this patient population.

Abstract Image

家用超声检查检测心力衰竭加重(HOUSE-HF)。
目的:急性失代偿性心力衰竭(ADHF)具有很高的发病率和死亡率。动态肺超声伪影称为b线,可在床边获得,与肺血管充血直接相关。在门诊环境中获得患者进行的肺部超声图像是新颖的。我们评估了最近因ADHF住院的患者使用手持式超声探头自行进行有限肺部超声检查并将图像上传到安全云以供医生解释的可行性。方法:采用前瞻性观察方便样本。患者从一个城市三级学术医疗中心招募,如果他们患有慢性左侧心力衰竭,无论射血分数如何,都符合条件。住院期间,患者接受了20分钟关于六肺区图像协议的教育,如何使用云档案系统,并给予手持超声换能器和智能平板电脑。在整个研究过程中,智能平板电脑上也有一个简短的教学视频(https://www.dropbox.com/scl/fi/bii7ovdcv21ps7yxyqsy1/120-21080-00-Rev-01-BNI-041-UPENN-IN-APP-TRAINING-VIDEO.mp4?rlkey=f5vu55xbnugdoz6jzyb8lv872&st=56es4qif&dl=0)。患者被要求每周上传三次图片,持续三周,总共进行了九项研究。检查所有图像并计算每个肺区b线评分,以及整个检查的总b线评分。此外,患者还完成了一项调查,以评估以患者为中心的体验。结果:共有15名患者入组,所有患者完成了7项或更多的研究(10名患者完成了全部9项研究)。患者年龄中位数为63岁(范围28 ~ 86岁),男性居多(73%),白人居多(60%),平均体重指数为33 kg/m2。其中33.3%的患者射血分数为50.0%,平均住院时间为6.3天。792张电位图像中,获得788张(99.5%)。其中,637次扫描是可解释的(80.8%)。右上肺尖区(1R区)最适合解释(96.2%),而左下腋中区(3L区)最不适合解释(69.5%)。每六幅图像扫描的平均b线数为3(范围为0-13)。患者调查数据确定3L区是最难获得的,对研究教材的总体满意度很高。结论:本中试研究表明,住院ADHF患者可以学习使用手持式便携式超声设备,获取并上传高质量的肺部超声图像。对研究方案的依从性和获得一些图像的能力非常好。需要进一步的研究来确定患者进行的肺部超声是否可以帮助发现和管理急性恶化的心衰。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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