Lung ultrasound-guided management to reduce hospitalization in chronic heart failure: a systematic review and meta-analysis

Heart Fail Rev. 2022 May;27(3):821-826. doi: 10.1007/s10741-021-10085-x. Epub 2021 Apr 9.


Pulmonary edema is a leading cause of hospital admissions, morbidity, and mortality in heart failure (HF) patients. A point-of-care lung ultrasound (LUS) is a useful tool to detect subclinical pulmonary edema. We performed a comprehensive literature search of multiple databases for studies that evaluated the clinical utility of LUS-guided management versus standard care for HF patients in the outpatient setting. The primary outcome of interest was HF hospitalization. The secondary outcomes were all-cause mortality, urgent visits for HF worsening, acute kidney injury (AKI), and hypokalemia rates. Pooled risk ratio (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using random-effect model meta-analysis. A total of 3 randomized controlled trials including 493 HF patients managed in the outpatient setting (251 managed with LUS plus physical examination (PE)-guided therapy vs. 242 managed with PE-guided therapy alone) were included in the final analysis. The mean follow-up period was 5 months. There was no significant difference in HF hospitalization rate between the two groups (RR 0.65; 95% CI 0.34-1.22; P = 0.18). Similarly, there was no significant difference in all-cause mortality (RR 1.39; 95% CI 0.68-2.82; P = 0.37), AKI (RR 1.27; 95% CI 0.60-2.69; P = 0.52), and hypokalemia (RR 0.72; 95% CI 0.21-2.44; P = 0.59). However, LUS-guided therapy was associated with a lower rate for urgent care visits (RR 0.32; 95% CI 0.18-0.59; P = 0.0002). Our study demonstrated that outpatient LUS-guided diuretic therapy of pulmonary congestion reduces urgent visits for worsening symptoms of HF. Further studies are needed to evaluate LUS utility in the outpatient treatment of HF.

Keywords: Heart failure; Lung ultrasound; Outpatient management; Pulmonary edema.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Kidney Injury* / complications
  • Chronic Disease
  • Female
  • Heart Failure* / complications
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / therapy
  • Hospitalization
  • Humans
  • Hypokalemia* / complications
  • Lung / diagnostic imaging
  • Male
  • Pulmonary Edema* / diagnostic imaging
  • Pulmonary Edema* / etiology
  • Pulmonary Edema* / therapy
  • Ultrasonography, Interventional / adverse effects