scholarly journals When to increase or reduce sodium loading in the management of fluid volume status during acute decompensated heart failure

2014 ◽  
Vol 1 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Shinichi Hirotani ◽  
Tohru Masuyama
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Fluid Volume ◽  
Volume Status ◽  
Sodium Loading

scholarly journals Hospitalist perspectives of available tests to monitor volume status in patients with heart failure: a qualitative study

2020 ◽  
Author(s):  
Anna M Maw ◽  
Carolina Ortiz-lopez ◽  
Megan A Morris ◽  
Christine Jones ◽  
Elaine Gee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lung Ultrasound ◽  
Acute Decompensated Heart Failure ◽  
Point Of Care ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Structured Interviews ◽  
Patients With Heart Failure ◽  
The Us ◽  
Time Required

AbstractAcute decompensated heart failure is the leading admitting diagnosis in patients 65 and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in 5 geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.

scholarly journals B-type natriuretic peptide levels and diagnostic accuracy: excess fluid volume

2020 ◽  
Vol 41 (spe) ◽  
Author(s):  
Melina Maria Trojahn ◽  
Sofia Louise Santin Barilli ◽  
Daniela de Souza Bernardes ◽  
Letícia Lopez Pedraza ◽  
Graziella Badin Aliti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Fluid Volume ◽  
Wilcoxon Test ◽  
Test Results ◽  
Nursing Assessment ◽  
Final Assessment ◽  
Nursing Diagnosis

ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.

Abstract 346: A Trial of Pre-discharge Point of Care Ultrasound for Acute Decompensated Heart Failure

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Neal Olarte ◽  
Mark Jacobs ◽  
Louis Vincent ◽  
Jonathan Salter ◽  
Aileen Andreu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Readmission Rate ◽  
Clinical Decision Making ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Volume Status ◽  
Fiscal Year ◽  
Point Of Care Ultrasound ◽  
Increased Risk ◽  
B Lines

Background: Acute decompensated heart failure (ADHF) is a primary reason for hospital admission and readmission in the elderly. Prior studies have demonstrated that sonographic pulmonary B-lines and large inferior vena cava (IVC) diameter with reduced collapsibility may accurately predict ADHF readmission. Ultrasound is a readily available bedside tool that can be used to assess a patient’s volume status, which can be difficult to assess under certain clinical conditions. The purpose of this project is to determine if a pre-discharge focused lung and IVC ultrasound exam can be used to predict readmission in a veteran patient population. Methods: This is a single-center study conducted at the Miami Veterans Affair Medical Center (VAMC). Only patients with a primary diagnosis of ADHF admitted to a hospitalist team through the emergency room will be considered. Exclusion criteria include: pre-existing structural lung disease; primary right-sided heart failure; severe tricuspid regurgitation; or hospice status. A single operator will evaluate all included patients for B-lines and IVC dimension within 24 hours of admission and discharge. Ultrasound results, without management recommendations, will be given to hospitalists to use at their discretion to support clinical decision-making. Patients will be categorized based on positive or negative ultrasound findings. The primary outcome of interest is 30-day readmission rate. Secondary outcomes include 90-day readmission, all-cause mortality, length of stay, and changes in weight or renal function. Chi-square and Mann-Whitney testing will be used to analyze categorical and continuous variables, respectively. Kaplan-Meier survival curves will be generated for both patient cohorts. Results/Anticipated Results: Through quarter 3 of fiscal year 2019, the Miami VAMC had 215 unique admissions for ADHF. The average 30-day readmission rate per quarter was 18.44% (total 40 of 215). Study enrollment is ongoing. We anticipate that many patients may demonstrate discrepancy of volume status between their clinical and ultrasound exams, and that patients found to have B-lines and/or large IVCs with poor collapsibility will have worse outcomes. Conclusion: Decreasing readmissions for acute decompensated heart failure is a priority for both patients and physicians. Persistent volume overload has been associated with increased risk for readmission. Ultrasound may be a useful augmentation to the physical exam to determine a patient’s volume status to further guide inpatient treatment, predict prognosis, and determine readiness for discharge.

scholarly journals Discharge-ready volume status in acute decompensated heart failure: a survey of hospitalists

2020 ◽  
Vol 10 (3) ◽  
pp. 199-203
Author(s):  
Anna M. Maw ◽  
Brian P. Lucas ◽  
Brenda E. Sirovich ◽  
Nilam J. Soni
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Volume Status

International comparison of clinical use of inotrope and vasodilator therapy for acute decompensated heart failure

2008 ◽  
Vol 7 ◽  
pp. 60-61
Author(s):  
H YOKOYAMA ◽  
S NAKATANI ◽  
K HASHIMURA ◽  
M KITAKAZE ◽  
Y GOTO ◽  
...  
Keyword(s):  
Heart Failure ◽  
International Comparison ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Clinical Use ◽  
Vasodilator Therapy
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