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Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design

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Figure 1

Study protocol scheme.
Study protocol scheme.

Figure 2

Eight standard positions for visualisation of B-lines in lung POCUS.
Eight standard positions for visualisation of B-lines in lung POCUS.

Study data collection list (HF – heart failure; NYHA – New York Heart Association classification; HFrEF – heart failure with reduced ejection fraction; HFmrEF – heart failure with mid-range ejection fraction; HFpEF – heart failure with preserved ejection fraction).

CategoryData variableMeasurement descriptionData source
Demographic dataAgeIn full yearsMedical record
GenderMale or femaleMedical record
Baseline clinical characteristicsMultimorbidityYes if more than 2 chronic diseasesMedical record
Charlson Comorbidity IndexUsing MDCalc softwareMedical record
Previously diagnosed heart failureYes if any evidenceMedical record
Current therapyNumber of all prescribed medicinesMedical record
Start-point health barometerSelf-evaluatedInterview
Start-point NYHAOn scale I–IVInterview and clinical examination
History of coronary artery diseaseYes if any evidenceMedical record
Clinical historyHistory of arterial hypertensionYes if any evidenceMedical record
Exposition to cardiotoxic drugs/radiationYes if any evidenceMedical record
Use of diureticsYes if any evidenceMedical record
Orthopnoea / paroxysmal nocturnal dyspnoeaYes if declared or any evidenceInterview or medical record
Signs of heart failureRalesYes if bilateralClinical examination
Bilateral ankle oedemaYes if bilateralClinical examination
Heart murmurYes if heardClinical examination
Jugular venous dilatationYes if observed in sitting positionClinical examination
Laterally displaced / broadened apical beatYes if feltClinical examination
Diagnostics of heart failureECGAny abnormalityStudy
NT-proBNPPositive if ≥125 pg/mLStudy
EchocardiographyCategorisation in HFrEF, HFmrEF, HFpEFStudy
OutcomesEvents related to HF deteriorationThe need for the iv diuretic, the emergency service intervention, hospitalisations for non-injury cause or deathStudy
Days to deterioration of heart failureFor any event related to HF deteriorationStudy
Change in health barometerSelf-evaluatedStudy
Change in NYHA classOn scale I–IVStudy
Days in hospital due to heart failureFor HF deterioration onlyStudy
Days alive and out of hospitalExcluding hospital days for whatever causeStudy
WorkloadDays aliveTime to death for whatever causeStudy
Non-administrative contactsAll and HF relatedStudy
Therapy modificationsAll and HF relatedStudy
Unplanned referralsAll and HF relatedStudy

Inferior vena cava diameter and collapsibility evaluation (adapted and modified from Kircher, et al. (22) and Papadimos, et al. (23)).

CategoryEstimated inferior vena cava diameterCollapsibilityEstimated central venous pressure
Small<1.5 cm>50%0–5 mm Hg
Medium1.5–2.5 cm>50%<50%6–10 mm Hg11–15 mm Hg
Large>2.5 cm<50%>16 mm Hg

Follow-up plan.

Test-retest reliabilityAt inclusionAt inclusionAt inclusionAt inclusionAt inclusion
Intervention groupPhysical examination++++-
POCUS++++-
Evaluation of HF deteriorations+++++
Control groupPhysical examination++++-
POCUS+----
Evaluation of HF deteriorations+++++
eISSN:
1854-2476
Langue:
Anglais
Périodicité:
4 fois par an
Sujets de la revue:
Medicine, Clinical Medicine, Hygiene and Environmental Medicine