A prospective observational study evaluated the effectiveness of a double-check protocol using point-of-care ultrasound (POCUS) in managing acute heart failure (AHF) in the emergency department (ED). A total of 96 patients diagnosed with AHF underwent multi-organ ultrasound assessments, including cardiac, pulmonary, and inferior vena cava evaluations. The protocol identified an alternative diagnosis in 33% of patients, leading to changes in clinical management, such as admission or discharge decisions. Among patients with confirmed AHF, 73.4% presented clinically significant findings not previously identified, including reduced left ventricular ejection fraction (LVEF < 40%) or moderate-to-severe valvular disease. The protocol impacted nearly 47% of all cases by refining diagnoses or uncovering relevant pathologies.
The study emphasized POCUS as a valuable diagnostic tool in time-sensitive ED environments. By combining cardiac, lung, and inferior vena cava ultrasound evaluations, POCUS provided real-time insights into pathophysiological mechanisms underlying AHF and differential diagnoses. Lung assessments revealed distinct patterns of B-lines, aiding in the differentiation of cardiogenic causes from alternative pathologies, such as pneumonia or respiratory infections. An asymmetry index was introduced to measure the symmetry of B-lines, further enhancing diagnostic accuracy.
Findings highlighted that multi-organ ultrasound assessment is superior to traditional diagnostic methods alone. POCUS proved instrumental in ensuring accurate diagnosis, reducing misclassification rates, and identifying additional clinically relevant findings. The study underscores the importance of integrating ultrasound protocols into routine AHF management in the ED, optimizing patient outcomes, and advancing personalized care approaches.
