Diagnosis of patients with heart failure with preserved ejection fraction in primary care : Cohort study

Journal article


Forsyth, Faye, Brimicombe, James, Cheriyan, Joseph, Edwards, Duncan, Hobbs, F. D. Richard, Jalaludeen, Navazh, Mant, Jonathan, Pilling, Mark, Schiff, Rebekah, Taylor, Clare J., Zaman, M. Justin, Deaton, Christi, OPTIMISE HFpEF investigators and collaborators and Wellwood, Ian*. (2021). Diagnosis of patients with heart failure with preserved ejection fraction in primary care : Cohort study. ESC Heart Failure. 8(6), pp. 4562-4571. https://doi.org/10.1002/ehf2.13612
AuthorsForsyth, Faye, Brimicombe, James, Cheriyan, Joseph, Edwards, Duncan, Hobbs, F. D. Richard, Jalaludeen, Navazh, Mant, Jonathan, Pilling, Mark, Schiff, Rebekah, Taylor, Clare J., Zaman, M. Justin, Deaton, Christi, OPTIMISE HFpEF investigators and collaborators and Wellwood, Ian*
Abstract

Aims
Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure (HF), but low awareness and diagnostic challenges hinder identification in primary care. Our aims were to evaluate the recruitment and diagnostic strategy in the Optimise HFpEF cohort and compare with recent recommendations for diagnosing HFpEF.

Methods and results
Patients were recruited from 30 primary care practices in two regions in England using an electronic screening algorithm and two secondary care sites. Baseline assessment collected clinical and patient-reported data and diagnosis by history, assessment, and trans-thoracic echocardiogram (TTE). A retrospective evaluation compared study diagnosis with H2FPEF score and HFA-PEFF diagnostic algorithm. A total of 152 patients (86% primary care, mean age 78.5, 40% female) were enrolled; 93 (61%) had HFpEF confirmed. Most participants had clinical features of HFpEF, but those with confirmed HFpEF were more likely female, obese, functionally impaired, and symptomatic. Some echocardiographic findings were diagnostic for HFpEF, but no difference in natriuretic peptide levels were observed. The H2FPEF and HFA-PEFF scores were not significantly different by group, although confirmed HFpEF cases were more likely to have scores indicating high probability of HFpEF.

Conclusions
Patients with HFpEF in primary care are difficult to identify, and greater awareness of the condition, with clear diagnostic pathways and specialist support, are needed. Use of diagnostic algorithms and scores can provide systematic approaches to diagnosis but may be challenging to apply in older multi-morbid patients. Where diagnostic uncertainty remains, pragmatic decisions are needed regarding the value of additional testing versus management of presumptive HFpEF.

Keywordsheart failure; primary health care; diagnostic tests; algorithms
Year2021
JournalESC Heart Failure
Journal citation8 (6), pp. 4562-4571
PublisherJohn Wiley & Sons Ltd
ISSN2055-5822
Digital Object Identifier (DOI)https://doi.org/10.1002/ehf2.13612
Scopus EID2-s2.0-85115643846
PubMed Central IDPMC8712851
Open accessPublished as ‘gold’ (paid) open access
Page range4562-4571
FunderNational Institute for Health Research (NIHR)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online21 Sep 2021
Publication process dates
Accepted30 Aug 2021
Deposited02 Dec 2022
Grant IDSchool for Primary Care Research Grant 384
BRC-1215-20014
Additional information

*Ian Wellwood is a member of the OPTIMISE HFpEF investigators and collaborators.

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