Letter to the Editor
Considerations for clinical ultrasound in patients with heart failure treated in home hospitalization
Consideraciones sobre la ecografía clínica en pacientes con insuficiencia cardiaca atendidos en hospitalización a domicilio
a Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital Doctor Balmis de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
b Área de Urgencias, Hospital Clínic, Barcelona, Spain
c Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
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Regarding the study population, the degree of congestion was not characterised with a multiparametric quantification of congestion using clinical scales based on standard clinical parameters, a venous congestion grading system and biomarkers, which would have defined the two groups in a more homogeneous way.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In addition to this, the patients were referred from heterogeneous levels of care, both outpatient and inpatient, so the severity or degree of congestion would also be different, as they were a group of patients who had already received diuretic treatment and had begun to stabilise and improve, and where the degree of congestion on admission would be lower - in the case of those referred from the emergency department or internal medicine - than in the group referred for admission from outpatients and primary care. As for the admission criteria, it was specified that patients needed to have respiratory stability, allowing the selection of patients with minimal congestion, residual congestion or mild congestion, and this aspect should have been specified due to its importance in the classification of patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In terms of treatment guided by clinical ultrasound, the diameter of the inferior vena cava and its collapsibility were determined exclusively; its sole determination is not currently recommended, as it may lead to certain biases in determining congestion, as its dilatation may be due not only to volume overload or congestive heart failure, but to other aetiologies, such as primary or secondary pulmonary hypertension, constrictive pericarditis, cardiac tamponade, etc., therefore, the Venous Excess Ultrasound Score (VExUS) is currently recommended as a strategy to determine the degree of venous congestion and guide treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> An important point is that the section on the intervention does not specify how each doctor responsible for the patient acted in terms of treatment and with which diuretic regimens or doses, and whether the intensity of the treatment depended on the doctor or whether there was variability in these aspects in each group, as different diuretic strategies, more or less aggressive, could have been used in each group and, therefore, the results could have varied. We also believe that the progression variables should have included emergency department revisits, which often lead to stays in observation areas and which are just as important, if not equally important, as hospitalization.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Finally, it should be noted that innovative studies such as that of Palacios García et al. make it possible to improve the quality of care for AHF patients admitted to these units.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of people and animals</span>: The authors declare that no experiments on humans or animals have been carried out for this research.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of data</span>: The authors declare that they have followed their institution's protocols on the publication of patient data.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent</span>: The authors declare that no patient data appear in this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare the absence of any funding.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacto de la ecografía clínica en pacientes con insuficiencia cardíaca atendidos en hospitalización a domicilio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. 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