Ultrasound-guided management in heart failure: A systematic review and meta-analysis evaluating lung and inferior vena cava ultrasound for reducing readmissions and mortality.

Importance: Hospital admissions due to HF exacerbations often occur due to vascular congestion. With point-of-care ultrasound (POCUS) becoming more prevalent, this systematic review was performed to identify its utility by using lung and/or IVC ultrasound to visualize vascular congestion to decrease all-cause mortality and/or hospital readmissions. Objective: To determine whether ultrasound-guided management using lung and/or IVC ultrasound reduces hospital readmissions and all-cause mortality in patients with HF compared to standard care. Data sources: Seven RCTs, published between 2019 and 2024, were identified through systematic searches of PubMed, Embase, Web of Science, and Google Scholar. Study selection: Two reviewers independently screened studies using PRISMA 2020 guidelines. Eligible studies were RCTs enrolling adults with HF in which diuretic therapy was guided by lung and/or IVC ultrasound, compared to standard care, reporting all-cause mortality or HF-related readmission. Studies were excluded if non-randomized, non-English, echocardiography-only, or involving pediatric populations. Data extraction and synthesis: Data extraction was manually performed and included study characteristics, participant demographics, ultrasound modality, and outcome measures. A DerSimonian-Laird random-effects model was applied to account for clinical and methodological heterogeneity. Main outcomes and measures: The primary outcomes, planned prior to data collection, included all-cause mortality and hospital readmissions for patients admitted for HF exacerbations when utilizing ultrasound-guided management versus standard care. The data was pooled and measured using a random-effects model to calculate RR with 95% confidence intervals (CI). Results: From the seven RCTs ( Conclusions and relevance: Seven RCTs totaling 824 patients showed that ultrasound-guided HF management significantly cut readmission risk without improving survival. A larger numerical reduction in the combined LUS + IVC subgroup is exploratory only based on two small trials and requires prospective confirmation before influencing clinical practice.