Document resource
Introduction The integrated programme in chronic disease (IPCD) places a focus on person-centred care delivered by specialists close to the patient’s home. Delivering on this vision requires specialists to confidently and reliably assess chronic diseases and their complications in community settings, without routine resource to hospital-based services. We report our experience using point-of-care ultrasound (POCUS) to assess patients with dyspnoea.Methods Eligible patients were identified from referrals to the Cardiology OPD at MRH Portlaoise between 24/04/24 and 21/08/24. Ultrasound evaluation comprised a focused ECHO and lung ultrasound.Results 37 people, 19 female, were included. Median age was 81. 12 (32%) had a history of CHF. 15 (41%) had normal Nt-proBNP. Of 21 (57%) with elevated NT-pro BNP, 12 (57%) had an Nt-proBNP >2000. 6 (16%) people had evidence of congestion on POCUS. 5 were managed wholly in the ambulatory setting, while 1 was subsequently admitted for inpatient diuretic therapy. The clinical utility of Nt-proBNP was limited. Of the 6 patients with congestion, Nt-proBNP ranged between 1400–3551. 2 of these patients had Nt-proBNP >2,000. Of 12 patients with Nt-proBNP >2,000 congestion was confirmed in 2 (17%). 20 people (54%) had a medication change at the clinic. 10 had changes to diuretic therapy, with 6 having initiation/escalation and 4 de-escalation. Further cardiac testing was requested for 5 patients. 31 (84%) people were discharged to GP. All patients for whom congestion was excluded were discharged after a single visit to GP follow-up. Over a median follow-up of 119 days, no patient assessed as not congested had an unscheduled visit or admission.Conclusion In our pilot, we demonstrate the use of POCUS to detect and rule-out congestion in an ambulatory setting. Detecting congestion led to therapy initiation, while exclusion allowed treatment de-escalation where appropriate and safe discharge to GP care.