Background: Heart failure is a common condition characterized by recurrent exacerbations. Medication and dietary nonadherence are associated with readmissions. Telling smokers their lung age significantly improves the likelihood of successful smoking cessation. We hypothesized that using hand-carried ultrasound (HCU) to share with patients their own images of inferior vena cava (IVC) measurements would serve as a motivational and educational tool, to improve medication and dietary adherence.
Methods: We enrolled 100 patients with acute decompensated heart failure (ADHF) who were admitted to the general medicine service at Johns Hopkins Bayview Medical Center. Baseline levels of adherence to medications, low salt diet and daily weight measurement were assessed by administering the Medical Outcomes Study Specific Adherence Scale, modified to a 3-item version relevant for patients with heart failure (MOSSAS-3HF, maximum score = 15, which indicates adherence “all of the time”). Then, patients were randomized into attention control group and educational intervention group. All patients underwent a limited bedside HCU examination of the IVC, but only patients in the intervention group were shown their own IVC images. MOSSAS-3HF was re-administered by telephone 30 days after discharge.
Results: MOSSAS-3HF scores for attention control group (M = 6.38, SD = 3.71) and educational intervention group (M = 7.36, SD = 3.35) were not significantly different at the time of enrollment in the study (p = 0.91). The score increased within both attention control group (M = 11.7, SD = 3.0) and educational intervention group (M = 11.8, SD 2.8) at 30 days after discharge, but the difference between the groups was not significant (p = 0.90). The rate of survival without readmission or presentation to emergency department (ED) at 30 days after discharge in attention control group (84.1%) and educational intervention group (82.6 %) was not significantly different (p = 0.85). Patients who were readmitted or presented to ED within 30 days after discharge were found to have a significantly lower MOSSAS-3HF score (M = 9.8, SD = 3.80) as compared to the ones who were not readmitted (M = 12.1, SD = 2.56) in this time period (p = 0.04).
Conclusions: In conclusion, sharing IVC images with patients with ADHF is not associated with improved reports of adherence to medication and diet restriction. However, higher total MOSSAS-3HF scores at 30 days predicted a lower risk of readmission and ED visit.