Impact of clinical ultrasound in patients with heart failure treated in home

BACKGROUND AND OBJECTIVE

In Spain, more than 10% of patients discharged with acute heart failure (AHF) are readmitted in the first 30 days. This study is designed to assess whether the treatment of AHF guided by clinical ultrasound (CU) in the setting of hospitalization at home (HAH) reduces the incidence of readmission and mortality compared to the standard care (SC).

PATIENTS AND METHODS

A randomized, open, parallel, single-center and controlled clinical trial (RCT) was designed (NT05042752). Patients >18 years of age admitted for AHF to HAD from January 2021 to April 2021 at the Reina Sofía Hospital in Tudela were consecutively included. The patients were randomized to the UG-ultrasound group (SC and CU performed) and the CG-control group (SC). The diuretic treatment was tailored according to the findings of the SC together with the CU or according to the findings of the SC respectively. The main variables were the relative risk of readmission and mortality from AHF.

RESULTS

A total of 79 patients were randomized, 39 to UG and 40 to CG. Of these, only 35 of the UG and 35 of the CG completed the intervention. The risk of readmission due to AHF was reduced by 60% in UG compared to CG (RR 0.4; 95% CI: 0.1-1) and mortality by 30% (RR 0.7; 95% CI: 0.2-2.2). Despite the relevant magnitude of the effect found, the results did not reach statistical significance due to lack of power.

CONCLUSION

Our results suggest that in HAH, a CE guided strategy for AHF could reduce the risk of readmission and mortality compared to SC alone. However, studies with greater statistical power are needed to confirm these results.

Colorectal endoscopic submucosal dissection is here to stay

Endoscopic mucosal resection (EMR) or mucosectomy and endoscopic submucosal dissection (ESD) are both techniques that have modified the therapeutic outlook of superficial gastrointestinal tract lesions and neoplasms. EMR is used for the en-bloc excision of lesions smaller than 2-3 cm or the piecemeal resection of larger ones. In theory, ESD achieves higher rates of en-bloc resections as compared to EMR with a lower rate of recurrence; however, it shows a higher percentage of complications, particularly in inexperienced centers or in centers at the start of their learning curve.