Objectives: The performed hand-held echocardiography (HHE) was evaluated and interpreted by trained advanced practice providers (APPs) on hospitalized CHF patients for image quality and interpretation by comparing with expert echocardiographer and SE findings. Background: Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While a standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. Methods: Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: (a) left ventricular (LV) size, (b) LV ejection fraction (LVEF), and (c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted the HHE images and compared them with APPs and SE findings. Kappa statistics determined the degree of agreement between APPs and the study echocardiographer’s interpretation of the HHE images and SE. Results: A total of 80 CHF patients (age 73 ± 14 years, 58% males; LVEF (by SE) 45 ± 19%; 36.3% body mass indexes ≥ 30 kg/m²) were enrolled. HHE interpretation by APPs had a good agreement for LVEF (kappa 0.79) with the study echocardiographer and SE (kappa 0.74) and a good agreement for RAP (kappa 0.67) with the study echocardiographer. The correlation between the absolute LVEF interpretation by the study echocardiographer on HHE and SE was r = 0.88 (p < 0.0001). Conclusions: Trained APPs obtained diagnostic-quality HHE images and interpreted the LV function and RAP in CHF patients in good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients, leading to expedited and optimized treatment.

**Introduction/Hypothesis:** Congestive Heart Failure (CHF) patients need rapid cardiac ultrasound assessment for prompt treatment. While standar | POSTER

Hand-Held Echocardiography by Trained Advanced Practice Providers in Patients with Congestive Heart Failure: A Pilot Study Maria Cecilia Tagle-Co | POSTER

To evaluate the effect of point-of-care ultrasound using handheld echocardiography (HHE) by trained advanced practice providers (APPs) on congestive heart failure (CHF) readmissions. This prospective cohort study comprised 140 consecutive patients with CHF admitted under cardiology service and involved an intervention group (n=67), in whom APPs trained in HHE assessed left ventricular ejection fraction and right atrial pressure (RAP) using HHE, and a control group (n=73) identified retrospectively during concurrent period, who received standard APP-delivered care without HHE. Advanced practice providers incorporated HHE findings into guideline-directed medical therapy (GDMT) decisions. Clinical characteristics, GDMT, length of stay, and 30-day all-cause and CHF readmissions were evaluated. Baseline demographic characteristics and medical therapy were similar except higher diabetes incidence in the HHE group (59.70% vs 32.88%; P<.01) and higher stroke (26.03% vs 10.45%; P<.05) and heart rate incidence (88±22 vs 80±15 bpm; P<.05) in the control group. Predischarge RAP on HHE was lower from admission in the study group. Considerable increases in GDMT prescription rates from admission to discharge occurred in both groups, but with no significant differences at discharge. Thirty-day CHF readmissions were lower in the HHE group (4.5% [95% CI, 0.9%-12.5%] vs 12.3% [95% CI, 5.7%-22.1%]; P<.05). Length of stay and 30-day all-cause readmissions were similar n both groups. In patients hospitalized with CHF, the addition of HHE-guided assessment by APPs was associated with lower predischarge RAP and reduced 30-day readmissions for CHF exacerbations. These hypothesis generating findings require validation in larger randomized trials.

Objectives: Evaluate hand-held echocardiography (HHE) performed and interpreted by trained Advanced Practice Providers (APPs) on hospitalized CHF patients for image quality and interpretation, by comparing against expert echocardiographer and SE findings. Background: Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. Methods: Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: a) Left ventricular (LV) size, b) LV ejection fraction (LVEF), and c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted HHE images and compared with APPs and SE findings. Kappa-statistics determined the degree of agreement between APPs and study echocardiographer interpretation of HHE images and SE. Results: 80 CHF patients [age 73±14 years, 58% males; LVEF (by SE) 45±19%; 36.3% body mass indexes ≥30 kg/m2] were enrolled. HHE interpretation by APPs had good agreement for LVEF (kappa 0.79) with study echocardiographer and SE (kappa 0.74), and good agreement for RAP (kappa 0.67) with study echocardiographer. Correlation between absolute LVEF interpretation by study echocardiographer on HHE and SE was r=0.88 (p<0.0001). Conclusions: Trained APPs obtained diagnostic-quality HHE images and interpreted LV function and RAP in CHF patients, with good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients leading to expedited and optimized treatment.