Lung ultrasound-guided decongestion reduces HF hospitalization and mortality risk in heart failure patients compared to standard care

BACKGROUND: Pulmonary congestion is a prognostic marker for heart failure (HF) morbidity and mortality; however, the current congestion evaluation depends on traditional physical examination, which lacks adequate sensitivity. Lung ultrasound (LUS) has been investigated as a more sensitive method to guide decongestion in decompensated HF. METHODS: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, CENTRAL, Scopus, and Web of Science until March 2025. Using Stata MP v. 17, we used the fixed-effects model to report dichotomous outcomes using the risk ratio (RR) and continuous outcomes using the standardized mean difference with a 95% confidence interval (CI). PROSPERO ID: CRD42024620337. RESULTS: Nine RCTs with 1095 patients were included. LUS-guided management significantly decreased the risk of HF hospitalization/all-cause mortality (RR: 0.72, [95% CI 0.56, 0.93], p = 0.01), HF hospitalization (RR: 0.65, [95% CI 0.48, 0.88], p = 0.01), and HF urgent visits (RR: 0.38, [95% CI 0.22, 0.66], p < 0.0001). There was no significant difference between LUS-guided management and standard of care regarding the incidence of hypotension (RR: 1.87, [95% CI 0.56, 6.20], p = 0.31), hypokalemia (RR: 0.93, [95% CI 0.48, 1.82], p = 0.83), hyperkalemia (RR: 0.98, [95% CI 0.62, 1.53], p = 0.91), and acute kidney injury/impaired renal function (RR: 1.08, [95% CI 0.66, 1.77], p = 0.75). CONCLUSION: LUS-guided decongestion was associated with a significant decrease in the risk of HF re-hospitalization and HF urgent visits, with a tolerable safety profile, compared to standard care, with similar rates of hypotension, hypokalemia, hyperkalemia, and AKI.