Missed opportunities in heart failure diagnosis and management: study of an urban UK population

Sylwia Migas; Michelle Louise Ellis; Bozydar Wrona; Elena Rivero Sanz; Jack Brownrigg; Otto Strauss; Fozia Zahir Ahmed

doi:10.1002/ehf2.14766

Missed opportunities in heart failure diagnosis and management: study of an urban UK population

ESC Heart Fail. 2024 Apr 16. doi: 10.1002/ehf2.14766. Online ahead of print.

Authors

Sylwia Migas¹, Michelle Louise Ellis², Bozydar Wrona¹, Elena Rivero Sanz², Jack Brownrigg², Otto Strauss², Fozia Zahir Ahmed^{3

4}

Affiliations

¹ NorthWest EHealth Ltd, 2nd Floor, Bright Building, Manchester Science Park, Pencroft Way, Manchester, M15 6GZ, UK.
² Pfizer Ltd, Tadworth, UK.
³ Department of Cardiology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
⁴ Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

PMID: 38627992
DOI: 10.1002/ehf2.14766

Abstract

Aims: This study aimed to examine the diagnostic pathways and outcomes of patients with heart failure (HF), stratified by left ventricular ejection fraction (EF), and to highlight deficiencies in real-world HF diagnosis and management.

Methods and results: We conducted a retrospective cohort study in Salford, United Kingdom, utilizing linked primary and secondary care data for HF patients diagnosed between January 2010 and November 2019. We evaluated characteristics, diagnostic patterns, healthcare resource utilization, and outcomes. Patients were categorized according to baseline (the latest measure prior to or within 90 days post-diagnosis) as having HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), or preserved EF (HFpEF). The data encompassed a 2 year period before diagnosis and up to 5 years post-diagnosis. A total of 3227 patients were diagnosed with HF between January 2010 and November 2019. The mean follow-up time was 2.6 [±1.9 standard deviation (SD)] years. The mean age at diagnosis was 74.8 (±12.7 SD) years, and 1469 (45.5%) were female. HFpEF was the largest cohort (46.6%, n_pEF = 1505), HFmrEF constituted 16.1% (n_mrEF = 520), and HFrEF 18.5% (n_rEF = 596) of the population, while 18.8% (n_u = 606) of patients remained unassigned due to insufficient evidence to support categorization. At baseline, measurement of natriuretic peptide (NP; brain NP and N-terminal pro-B-type NP) and echocardiographic report data were available for 592 (18.3%) and 2621 (81.2%) patients, respectively. A total of 2099 (65.0%) of the HF cohort had access to a cardiology-led outpatient clinic prior to the HF diagnosis, and 602 (18.7%) attended cardiac rehabilitation post-diagnosis. The 5 year crude survival rate was 37.8% [95% confidence interval (CI) (35.2-40.7%)], 42.3% [95% CI (38.0-47.2%)], and 45.5% [95% CI (41.0-50.4%)] for HFpEF, HFrEF, and HFmrEF, respectively.

Conclusions: Low survival rates were observed across all HF groups, along with suboptimal rates of NP testing and specialist assessments. These findings suggest missed opportunities for timely and accurate HF diagnosis, a pivotal first step in improving outcomes for HF patients. Addressing these gaps in diagnosis and management is urgently needed.

Keywords: Echocardiogram; Ejection fraction; Electronic medical records; Heart failure; Missed opportunity; Patient pathways.

Grants and funding

Pfizer Ltd