178 Lung ultrasound guided management in chronic heart failure- an updated systematic review and meta-analysis of randomised controlled trials

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Introduction Existing systematic reviews support the prognostic and therapeutic value of lung ultrasound (LUS) in heart failure (HF), but recent randomised controlled trials (RCTs) in chronic HF justify an up-to-date synthesis. Methods A systematic search of OVID via Medline, SCOPUS, COCHRANE and CINAHL was conducted from inception until February 20th, 2020. The study was registered with PROSPERO (ID: CRD420201003434). RCTs of LUS interventions in patients with chronic HF were included. The primary outcomes were HF hospitalisations and HF urgent visits. Secondary outcomes included mortality, hypokalaemia and worsening renal function. Results Five RCTs were identified and included in meta-analyses, involving a total of 694 patients. LUS interventions were associated with a significant reduction in HF urgent visits (RR 0.31 [95% CI 0.17, 0.55], I2= 0%) (figure 1) and a non-significant improvement in HF hospitalisations (RR 0.76 [95% CI 0.48, 1.18], I2= 38.9%) (figure 2). There was no difference in the rates of mortality, hypokalaemia or worsening renal function. Conclusions LUS is associated with a significant reduction in urgent HF visits and a non-significant reduction in HF hospitalisations, with no difference in rates of mortality, hypokalaemia or worsening renal function. Future studies should aim to establish a standardised LUS-based definition of pulmonary congestion in chronic heart failure.

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