Experiences of primary care nurses with using a handheld ultrasound device (Vscan) and a remote dielectric sensing (ReDS) device in the assessment of patients with heart failure
Authors: Mattisson M , Liljeroos M , Grahn P , Johansson P , Stromberg A , Jaarsma T , Kato N 
Published: July 2024

Abstract

Background
Early detection of increased lung fluids is vital to further prevent deterioration and treat worsening of heart failure (HF). However, nurses often face challenges in assessing the status of HF patients, especially in primary care, where specialized competence in cardiology may be lacking and many patients have co-morbidities. The handheld ultrasound device (Vscan) and remote dielectric sensing device (ReDS) have the potential to provide valuable support in these challenges.

Purpose
To describe the additional value of the information obtained with Vscan and ReDS in primary care, and to identify challenges encountered by nurses in relation to the measurements among HF patients.

Methods
One nurse in a Swedish primary healthcare centre used both devices on 17 separate occasions during January-June in 2023, involving a total of six patients (mean age 84.5 years, female 67%, NYHA II/III 33%/67%, lung disease 67%). The nurse made notes about the perceived value in the HF assessment and informativeness of the devices and any challenges encountered during the measurements using a self-administered questionnaire. Qualitative data was narratively reviewed and described.

Results
Information obtained from Vscan images such as pleural effusion and B-lines, and ReDS values contributed to the assessment of the HF status in patients, determining whether their condition worsened, remained stable or improved. These devices helped in verifying and confirming physical examination findings, including lung auscultation and subjective symptoms reported by the patient, such as shortness of breath and leg oedema. Additionally, the information (e.g., high ReDS value and the presence of B-lines) supported decisions on medication optimization, primarily through adjustments of diuretic dosages and initiation of new HF medications. It also helped to distinguish symptoms of asthma or chronic obstructive pulmonary diseases from worsening HF (e.g., presence of shortness of breath without B-lines and low ReDS value of 31). The nurse expressed uncertainty due to limited experience with using the devices, particularly when results from the two devises were not congruent. Trust in ReDS-data evolved over time and initial problems in managing the vest were resolved. Challenges associated with ReDS included difficulties in fitting the vest on patients with abnormal spine features and obesity, and issues arising from patient movements during measurements. Problems with Vscan included the generation and interpretation of ultrasound images, particularly in obese patients.

Conclusion
Our data suggests that both Vscan and ReDS have the potential to provide valuable information to primary care nurses in the daily management of HF patients, particularly for assessing HF status and optimizing medication. Further studies are needed to assess the effectiveness of these devices in improving patient outcomes in heart failure management in primary care.Handheld portable ultrasound (Vscan)ReDS device