Congestion and LActate at diScHarge in Acute Heart Failure

This is a prospective, multicenter, observational cohort study including adults (≥18 years) hospitalized for acute decompensated heart failure who were deemed clinically stable and scheduled for discharge within 24 hours. Patients with active severe infection or septic shock, significant hypoxemia or respiratory distress requiring advanced oxygen or ventilatory support, advanced liver disease, refusal to participate, or technical inability to perform lung ultrasound were excluded. At discharge, pulmonary congestion was assessed using lung ultrasound with a standardized 8-zone protocol, and venous blood lactate was measured under resting conditions. Demographic data, heart failure phenotype, discharge vital signs, laboratory values, treatments, and hospitalization characteristics were collected. The primary endpoint was a composite of heart failure-related readmission or all-cause mortality within 30 days after discharge. Secondary endpoints included all-cause readmission, emergency department visits at 30 days, and time to first event. Follow-up was conducted at 30 days using a standardized telephone interview and review of medical records, with strict criteria applied for the definition of heart failure readmission.

Inclusion criteria

• Age ≥ 18 years.
• Hospitalization for acute heart failure/decompensation (clinical diagnosis + imaging/laboratory tests according to local practice).
• Patient deemed ready for discharge (decision made by the team, discharge within 24 hours).

Exclusion criteria

• Septic shock/severe active infection at the time of discharge.
• Hypoxemia or respiratory distress requiring high-flow oxygen/ventilation at the scheduled time of discharge.
• Severe cirrhosis/advanced liver failure.
• Refusal to participate.
• Technical impossibility of LUS.