Journal Article

2 Definition of clinical stability following management of heart failure deterioration is suboptimal and benefits from focused echo evaluation

Barrett, M, Bruno, G, Mahon, C, McCaffery, D, Fabamwo, F, McDonald, K

2025

Overview

BackgroundHeart Failure (HF) decompensation is increasingly being managed in the outpatient setting. Following stabilisation, recurrent deterioration is frequently observed, presenting a challenge to physicians as accurate definition of clinical status is limited by the imprecise nature of clinical assessment. Therefore, the question arises as to whether clinical stability reflects true stability in resolved outpatient HF decompensation (HFD).AimsTo assess the clinical value of focused Doppler-Echocardiography (ECHO) in addition to clinical evaluation in defining stability following outpatient decompensation.MethodsThis is an interim analysis of an ongoing single-centre, observational study including all patients diagnosed with HFD in our HF clinic from December 2023-May 2025, defined as:A. ≥1 HF symptom or physical sign and ≥1 other feature of HFDORB. Patients not meeting these criteria but deemed to have HFD on the discretion of the treating physician. Both definitions require escalation in diuretic therapy.Upon stabilisation, ECHO analysis of volume status is carried out and assessed with persistent pressure/volume overload defined as an indirect measure of left ventricular filling pressure E/E’ ≥ 13 ± IVC respiratory variation < 50% (figure 1).Results248 patients are included in this study, of which 191 (77%) have been stabilised (table 1). ECHO assessment was completed in 137/191 and the following categories have been identified;A. Normal IVC and E/E’; 69/137(50%)B. Abnormal IVC/Normal E/E’; 39/137(29%)C. Normal IVC and elevated E/E’; 16/137(12%)D. Abnormal IVC and elevated E/E’; 13/137(9%ConclusionDetermination of clinical status post stabilisation is limited by the lack of sensitivity of clinical evaluation. The data reflects evidence of residual sub-clinical pressure/volume overload on ECHO, likely contributing to the risk of recurrence. ECHO analysis of volume status should be considered as a component of assessment in the evaluation of stability following HF decompensation.Abstract 2 Figure 1Breakdown of doppler-echocardiographic analysis of volume assessment upon stabilisation following outpatient heart failure decompensation. IVC = inferior vena cava; ECHO = doppler-echocardiographic[Image Omitted. See PDF.]Abstract 2 Table 1Selected baseline characteristics of patients. Values are reported as mean (S.D) or n (%) as appropriate. HFpEF = heart failure preserved ejection fraction; HFrEF = heart failure reduced ejection fraction; NT-proBNP HFD = NT-proBNP at the time of diagnosis of decompensated heart failure; NT-proBNP STABLE = NT-proBNP following resolved HFD when deemed stable[Image Omitted. See PDF.]

• Publisher: BMJ Publishing Group LTD
• Subject: Ejection fraction / Heart failure