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Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based
Aleksandra Puch-Walczak1, Katarzyna Kunicka2, Kacper Jagiełło3
1Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland. apw@gumed.edu.pl.
Insights
The prevalence of chronic heart failure (CHF) in the general population was found to be 4.8% using the 2016 ESC diagnostic algorithm. This algorithm is applicable for general population surveys, with targeted testing for dyspnea or prior CHF diagnosis.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Chronic heart failure (CHF) presents a significant global health challenge.
- Epidemiological data on CHF prevalence in the general population, using current clinical diagnostic standards, is lacking.
Purpose of the Study:
- To assess the prevalence of key components of the 2016 European Society of Cardiology (ESC) diagnostic algorithm for CHF.
- To evaluate the applicability of the 2016 ESC CHF diagnostic algorithm in general population studies.
Main Methods:
- A representative sample of 313 adults in Northern Poland (mean age 55.2 years) participated.
- Data collection included questionnaires for New York Heart Association (NYHA) class, N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, transthoracic echocardiography, and spirometry.
Main Results:
- Dyspnea (NYHA class II-IV) was reported by 13.7% of participants.
- The prevalence of CHF, defined by symptoms, elevated NT-proBNP, and echocardiographic abnormalities, was 4.8%.
- Among subjects without dyspnea, 1 in 6 had elevated NT-proBNP; 5.8% reported a prior CHF diagnosis, confirmed in 78% by the ESC algorithm.
Conclusions:
- The 2016 ESC diagnostic algorithm identified a 4.8% prevalence of CHF in this general adult population sample.
- The clinical algorithm is suitable for epidemiological surveys in the general population.
- Echocardiography and NT-proBNP testing could be prioritized for individuals with dyspnea or a history of CHF due to logistical and economic considerations.
Background:
Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice.
Aim:
The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples.
Methods:
The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects.
Results:
Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them.
Conclusions:
The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.
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