Prognostic value of jugular, pulmonary and inferior vena cava ultrasound in decompensated heart failure in primary care

Abstract

Background: Multiparametric ultrasound combining pulmonary and venous assessment (inferior vena cava [IVC] and internal jugular vein) is a feasible tool for characterizing hemodynamic congestion in patients with heart failure (HF) managed in Primary Care. Objective: To evaluate the short-term prognostic value of pulmonary and venous ultrasound in patients with decompensated HF treated with intravenous diuretics in community settings. Methods: Prospective cohort study including patients with decompensated HF attended between April 2024 and September 2025 across seven Primary Care teams of the Catalan Health Institute. Clinical, analytical, and ultrasound variables (IVC, jugular vein, and 8-zone lung ultrasound) were recorded. The primary outcome was a composite of death, HF hospitalisation, or new intravenous treatment within seven days. Results: A total of 197 patients were included (56.4 % women; mean age 84.7 ± 7.5 years). Signs of venous and pulmonary congestion were frequent at inclusion. Within seven days, 14.8 % of patients experienced the composite outcome. In multivariate analysis, IVC collapsibility <25 % (OR 3.70; 95 % CI 1.13–14.53; p = 0.039) and prior heart failure hospitalisation (OR 4.47; 95 % CI 1.48–14.10; p = 0.008) were independently associated with events, whereas lung and jugular ultrasound parameters were not. Conclusions: Multiparametric ultrasound performed in Primary Care allows identification and quantification of hemodynamic congestion in decompensated HF. Among evaluated parameters, only IVC collapsibility showed independent short-term prognostic value, supporting its integration into community-based risk stratification models.