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Characterisation of the patients with suspected heart failure: experience from the SHEAF registry
Pankaj Garg1, Ahmed Dakshi2, Hosamadin Assadi1
1IICD, The University of Sheffield, Sheffield, UK.
Insights
The National Institute for health and Care Excellence (NICE) heart failure (HF) algorithm effectively risk-stratifies patients using N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels. Higher NT-proBNP indicates a greater likelihood of HF and poorer prognosis.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Algorithms
Background:
- Heart failure (HF) diagnosis and risk stratification are critical for patient management.
- The National Institute for health and Care Excellence (NICE) provides an algorithm for suspected HF cases.
- Understanding patient prognoses based on diagnostic markers is essential for effective treatment strategies.
Purpose of the Study:
- To characterize and risk-stratify patients presenting to a heart failure (HF) clinic.
- To evaluate the effectiveness of the NICE HF diagnostic algorithm in a real-world setting.
- To assess the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels in suspected HF patients.
Main Methods:
- Observational study utilizing prospectively collected data from the Sheffield HEArt Failure registry.
- Inclusion of consecutive patients with suspected HF between April 2012 and January 2020.
- Outcome defined as all-cause mortality, with follow-up up to 6 years.
Main Results:
- 6144 patients enrolled; 71% diagnosed with HF.
- Elevated NT-proBNP (>2000 pg/mL) strongly correlated with HF diagnosis (92% vs. 64% for 400-2000 pg/mL).
- HF patients exhibited higher mortality (11.49 vs. 7.29 per 100 patient-years). NT-proBNP >2000 pg/mL associated with shorter survival (3.8 vs. 5 years). HFpEF and HFrEF showed comparable survival post-propensity matching.
Conclusions:
- The NICE HF diagnostic algorithm, using tiered NT-proBNP levels, effectively stratifies patients.
- Distinct patient groups with varied diagnoses and prognoses emerge from the algorithm's pathways.
- HF with preserved ejection fraction (HFpEF) is the most common HF phenotype, presenting significant challenges due to poor prognosis and limited therapeutic options.
Objectives:
To characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm.
Methods:
This is an observational study of prospectively collected data in the Sheffield HEArt Failure registry of consecutive patients with suspected HF between April 2012 and January 2020. Outcome was defined as all-cause mortality.
Results:
6144 patients were enrolled: 71% had HF and 29% had no HF. Patients with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) >2000 pg/mL were more likely to have HF than those with NT-proBNP of 400-2000 pg/mL (92% vs 64%, respectively). Frequency of HF phenotypes include: HF with preserved ejection fraction (HFpEF) (33%), HF with reduced ejection fraction (HFrEF) (29%), HF due to valvular heart disease (4%), HF due to pulmonary hypertension (5%) and HF due to right ventricular systolic dysfunction (1%). There were 1485 (24%) deaths over a maximum follow-up of 6 years. The death rate was higher in HF versus no HF (11.49 vs 7.29 per 100 patient-years follow-up, p<0.0001). Patients with HF and an NT-proBNP >2000 pg/mL had lower survival than those with NT-proBNP 400-2000 pg/mL (3.8 years vs 5 years, p<0.0001). Propensity matched survival curves were comparable between HFpEF and HFrEF (p=0.88).
Conclusion:
Our findings support the use by NICE's HF diagnostic algorithm of tiered triage of patients with suspected HF based on their NT-proBNP levels. The two pathways yielded distinctive groups of patients with varied diagnoses and prognosis. HFpEF is the most frequent diagnosis, with its challenges of poor prognosis and paucity of therapeutic options.
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