RECRUITINGINTERVENTIONAL

POCUS-Guided Diuresis for Decompensated Heart Failure

Point-of-Care Ultrasound-Guided Diuresis for Acute Decompensated Heart Failure to Reduce 30-Day Readmissions and Acute Kidney Injury

About This Trial

Heart failure occurs when the heart cannot pump blood effectively, leading to fluid buildup in the body. This can cause problems such as difficulty breathing, swelling, and extreme tiredness. In severe cases, these symptoms worsen to the point where hospitalization is required. Unfortunately, many patients with severe heart failure are readmitted to the hospital within 30 days after discharge, which is both physically and emotionally challenging for patients and places a significant financial burden on individuals and the healthcare system. Although symptoms such as difficulty breathing and swelling may improve during the hospital stay, some patients are discharged with excess fluid remaining in their bodies. This retained fluid often causes symptoms to worsen, leading to subsequent hospital readmissions. Inadequate management of fluid levels can also harm the kidneys, further complicating the patient's condition. This study aims to improve care for heart failure patients by utilizing a simple, non-invasive tool to assess fluid levels more accurately at the bedside. The tool measures the size of a large blood vessel in the neck, providing key information about the pressure inside the heart. This information enables clinicians to determine the appropriate amount of medication needed to remove just the right amount of fluid. Properly managing fluid levels can help prevent kidney damage and improve overall patient outcomes. The primary goal of this study is to evaluate whether this tool can reduce the number of patients readmitted to the hospital within 30 days of discharge. A secondary goal is to determine whether the tool can help protect kidney function by allowing for better fluid management. If successful, this approach has the potential to help heart failure patients stay healthier, reduce hospital visits, and lower healthcare costs.

Who May Be Eligible (Plain English)

List the Who May Qualify: 1. Age: Patients must be 18 years or older. 2. Diagnosis: Must have a confirmed diagnosis of acute decompensated heart failure (ADHF). 3. Treatment Plan: Patients must be planned for treatment with intravenous (IV) diuretics. 4. POCUS Measurement: Must have an abnormal right internal jugular vein (RIJV) distensibility index (DI) of \<66% on point-of-care ultrasound (POCUS) at the time of admission. These criteria ensure that participants are appropriately selected for the study and are likely to benefit from POCUS-guided diuretic management. List the Who Should NOT Join This Trial: 1. Left Ventricular Assist Devices (LVAD): Patients with LVADs will be excluded due to their unique hemodynamics, which may interfere with study assessments. 2. Anatomical Incompatibilities: Excludes patients with RIJV or superior vena cava thrombus, congenital heart disease, or severe tricuspid regurgitation, as these conditions may impair accurate POCUS measurements. 3. Cardiomyopathy: Patients with hypertrophic or infiltrative cardiomyopathy will be excluded. 4. End-of-Life Care: Patients receiving hospice care or comfort measures only will not be included in the study. 5. Advanced Cancer: Patients with metastatic cancer will be excluded. 6. Severe Liver Dysfunction: Patients with a MELD-Na score greater than 20, indicating severe liver dysfunction, will be excluded. 7. End stage chronic kidney disease 8. Inability to Provide Consent: Patients who are unable to provide willing to sign a consent form, due to cognitive impairment or other reasons, will not be eligible. 9. Inotropic Support: Patients requiring inotropic support at the time of enrollment will be excluded, as they represent a more severe heart failure profile that may not be suitable for this trial. Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

List the inclusion criteria: 1. Age: Patients must be 18 years or older. 2. Diagnosis: Must have a confirmed diagnosis of acute decompensated heart failure (ADHF). 3. Treatment Plan: Patients must be planned for treatment with intravenous (IV) diuretics. 4. POCUS Measurement: Must have an abnormal right internal jugular vein (RIJV) distensibility index (DI) of \<66% on point-of-care ultrasound (POCUS) at the time of admission. These criteria ensure that participants are appropriately selected for the study and are likely to benefit from POCUS-guided diuretic management. List the exclusion criteria: 1. Left Ventricular Assist Devices (LVAD): Patients with LVADs will be excluded due to their unique hemodynamics, which may interfere with study assessments. 2. Anatomical Incompatibilities: Excludes patients with RIJV or superior vena cava thrombus, congenital heart disease, or severe tricuspid regurgitation, as these conditions may impair accurate POCUS measurements. 3. Cardiomyopathy: Patients with hypertrophic or infiltrative cardiomyopathy will be excluded. 4. End-of-Life Care: Patients receiving hospice care or comfort measures only will not be included in the study. 5. Advanced Cancer: Patients with metastatic cancer will be excluded. 6. Severe Liver Dysfunction: Patients with a MELD-Na score greater than 20, indicating severe liver dysfunction, will be excluded. 7. End stage chronic kidney disease 8. Inability to Provide Consent: Patients who are unable to provide informed consent, due to cognitive impairment or other reasons, will not be eligible. 9. Inotropic Support: Patients requiring inotropic support at the time of enrollment will be excluded, as they represent a more severe heart failure profile that may not be suitable for this trial.

Treatments Being Tested

OTHER

Furosemide (Standard Diuretic) Treatment

Participants in this group will receive intravenous furosemide as part of their routine care, based on clinical assessments including symptoms, physical examination. Daily POCUS imaging will be performed for research purposes; however, the findings will not be shared with the treating clinical team. Fluid management decisions and discharge planning will follow usual care protocols, without additional imaging-based guidance.

OTHER

POCUS-Assessed Diuretic Management

POCUS will be used to provide objective, non-invasive assessments of fluid status by measuring right internal jugular vein (RIJV) cross-sectional area (CSA) and calculating the Distensibility Index (DI). This information will be shared with the treating clinical team as an additional tool for fluid management. However, all final decisions regarding diuretic therapy will be made at the discretion of the treating physicians.