Inferior vena cava (IVC) ultrasonography is an increasingly valuable tool for managing patients with chronic heart failure (HF), yet its use in primary care settings is not well describedThis study aims to evaluate the prevalence of ultrasound-assessed congestion in HF outpatients seen in primary care.A cross-sectional observational study was conducted involving all patients diagnosed with HF in five consultation units at our primary care center in Sant Feliu de Llobregat, a city within the province of Barcelona, who agreed to participate, and they could travel to the centre. A total of 120 patients over 18 years of age were contacted. Collected data comprised sociodemographic factors and cardiovascular clinical characteristics. Ultrasound congestive HF was defined as an IVC diameter ≥21 mm or an inspiratory collapse <50%. Clinical congestion HF was considered present if two or more relevant symptoms worsened (dyspnea, edema, weight gain, jugular vein distention) 1,3. The IVC ultrasonography was performed by doctors from the center trained in 3 sessions of 2 hours each. A descriptive analysis was performed.Finally, 77 participants were included and 43 excluded due to multimorbidy or mobility problems. Were female 47(61.0%), with a mean age of 80 years. Fifty-one (66.2%) patients had more than two cardiovascular comorbidities, 52(67.5%) had HFpEF, and 21(27.2%) had HFrEF, and 53 (68.8%) had polypharmacy (>5 medications). Ultrasound evidence of congestion was found in 17 participants (22.1%), whereas clinical congestion was identified in only 7 (9,1%).Ultrasound-detected congestion appeared more frequently than clinical congestion during HF follow-up visits in primary care. In older populations, where clinical assessment is often challenging, ultrasonography could have a prominent role easy to perform for evaluating congestion status.The prevalence of ultrasound-assessed congestion in outpatients seen with HF treated in primary care is high. IVC ultrasonography could be a valuable tool for the follow-up of patients with HF, allowing for early identification of patients at high risk of deterioration. These findings highlight the need for further research.