Use of Imaging-guided Decongestion for Reducing Heart Failure Readmission and Death in High-risk Patients: A Multi-site Randomized Trial of a Nurse-led Strategy at the Point of Care

Background: Nurse -led disease management programs (DMPs) decrease readmission after acute decompensated heart failure (HF). We sought whether readmissions could be further reduced by lung ultrasound (LUS)-guided decongestion before discharge and during DMP. Methods and Results: Of 290 patients hospitalized with acute decompensated HF, 122 at high risk for readmission or mortality were randomized to receive usual care (UC) ( n = 64) or UC plus intervention (DMP-Plus) ( n = 58), comprising LUSguided management before discharge and during at-home follow-up. Residual congestion was identi fi ed by >= 10 B -lines detected in 8 lung zones. The outcomes included a composite of readmission and/or mortality at 30 and 90 days, and 90day HF readmission. Residual congestion was detected equally among the patient groups. The 30 -day composite outcome occurred in 28% DMP-plus patients and 22% UC patients (odd ratio [OR], 1.36; 95% con fi dence interval [CI], 0.59-3.1; P = .5) and the 90 -day HF readmission outcome occurred in 22% and 31%, respectively (odds ratio, 0.63; 95% CI, 0.28-1.43; P = .3). Residual congestion, identi fi ed at predischarge LUS examination in high -risk patients, was associated with early ( < 14 -day) HF readmission (relative risk, 1.19; 95% CI, 1.06-1.32; P = .002) and multiple ( >= 2) readmissions over 90 days of follow-up (relative risk, 1.09; 95% CI, 1.01-1.16; P = .012), independent of demographics and comorbidities. Conclusions: Readmission in patients with incomplete decongestion before discharge occurs within the fi rst 2 weeks. However, our DMP-plus strategy did not improve the primary outcome. ( J Cardiac Fail 2024;30:624 - 629 )