Lung ultrasound in ED to manage acute HF confers no benefit vs. usual care
A strategy of care based on lung ultrasound in the ED for pulmonary congestion in acute HF showed no benefit in reducing B-line numbers compared with usual care, according to new study findings.
“Lung ultrasound is an objective method to quantify pulmonary congestion via measurement of extravascular lung water signals, known as B-lines,” Peter S. Pang, MD, from the department of emergency medicine at Indiana University School of Medicine, Indianapolis, and colleagues wrote in the Journal of the American College of Cardiology: Heart Failure. “Preliminary data suggest that B-lines may be used as an objective measure of response to therapy in patients with acute HF.”
Researchers conducted the BLUSHED-AHF study, a multicenter, single-blind, randomized controlled pilot trial that included 130 adult patients with a history of HF, shortness of breath and with at least one sign or radiographic evidence for acute HF. Patients were randomly assigned to receive a 6-hour lung ultrasound-guided treatment strategy (n = 66) or structured usual care (n = 64). Patients were followed up during hospitalization and at 90 days after hospital discharge.
The primary outcome was B-lines < 15 at 6 hours. Secondary outcomes included days alive and out of hospital at 30 days.
There was no difference in the proportion of patients with B-lines < 15 by 6 hours among those who received lung ultrasound-guided treatment (25%) or structured usual care (27.5%; P = .83). In addition, researchers observed no difference in number of B-lines at 6 hours for the lung ultrasound-guided treatment group (35.4) or the structured usual care group (34.3; P = .82).
For days alive and out of hospital, there were no differences between the lung ultrasound-guided treatment group and the structured usual care group (21.3 in both groups; P = .99).
Researchers observed a greater B-line reduction among those in the lung ultrasound-guided treatment group compared with those in the structured usual care group during the first 48 hours of treatment (P = .04).
In an accompanying editorial, Stephen J. Greene, MD, and Muhammad Shahzeb Khan, MD, MSc, assistant professors of medicine in the division of cardiology at Duke University School of Medicine, noted that these findings demonstrate lung ultrasound-guided treatment as feasible, but the search continues for a practical, noninvasive, objective and highly reproducible approach for in-hospital decongestive HF therapy.
“The authors should be congratulated for this novel and well-executed study, especially in a population where logistics of early enrollment soon after presentation to the emergency department can be challenging,” Greene and Shahzeb wrote. “BLUSHED-AHF leveraged lung ultrasound in efforts to add more objectivity to the assessment of congestion and the trial offers important points for consideration.”