THE USE OF POINT OF CARE ULTRASOUND TO GUIDE MANAGEMENT IN HEART FAILURE
Ilan Kedan, M.D., Cedars Sinai Heart Institute, Beverly Hills, CA, USA
Background: Point of Care (POC) ultrasound (US) has long been used in the acute care and emergency setting for management of trauma patients. Our clinical group has applied the data acquired from POC US to assist in management of chronic heart failure (HF) patients in the ambulatory setting.
Protocol: Cardiologists selected 250 NYHA Class II-IV HF patients at high risk for hospitalization from a panel of 5500. These patients were enrolled in a clinical pharmacist run HF clinic that focused on medication safety and optimization, coordination of care, and patient education. Serial inferior vena cava measurements and serial assessment of pleural effusions were acquired with GE Vscan point of care ultrasound and were used to guide of therapeutic optimization.
Results and Discussion: 220 and 164 patients were analyzed at 6 and 12 months before and after enrollment in the program. Total inpatient hospitalization days in the 6 month cohort was 897 days pre-enrollment and 313 after enrollment (p <0.001). Total inpatient hospitalization days in the 12 month cohort was 818 days pre-enrollment and 343 after enrollment (p <0.001).
We have demonstrated that with the use of POC US we have been able to acquire serial anatomic measurements that results in actionable data for patient management in the ambulatory care setting. These data have allowed us to better personalize care to improve heart failure outcomes and decrease heart hospitalization.