Diagnostic Yield from Screening and Health Status Burden of Outpatients at Risk for Heart Failure

Area of Science:

• Cardiology
• Primary Care Medicine
• Diagnostic Screening

Background:

• Heart failure (HF) is often underdiagnosed in primary care due to nonspecific symptoms and infrequent screening.
• This leads to patients being diagnosed with advanced disease, impacting their quality of life and functional capacity.

Purpose of the Study:

• To assess the effectiveness of screening at-risk outpatients for HF using a noninvasive measure of left ventricular end-diastolic pressure (LVEDP).
• To characterize the health status of patients identified with elevated LVEDP through this screening method.

Main Methods:

• A convenience sample of adults with diabetes mellitus (DM), chronic kidney disease (CKD), or suspected HF were screened.
• The Vivio System was used for noninvasive LVEDP assessment, with positive screening defined as LVEDP >18 mmHg.
• Health status was evaluated using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score for patients with positive screening results.

Main Results:

• Out of 2040 screened patients, 38.5% had an elevated LVEDP.
• Older age, female sex, and presence of CKD were associated with higher likelihood of elevated LVEDP (p<0.01).
• Among 653 patients with KCCQ-OS scores, 31.4% were asymptomatic (KCCQ-OS=100), while 26.5% had scores <80, indicating NYHA class II-IV symptoms.

Conclusions:

• Noninvasive LVEDP screening identified a substantial proportion of at-risk primary care patients with elevated LVEDP.
• Over two-thirds of patients with positive screening reported significant health status impairments.
• Combining noninvasive LVEDP assessment with KCCQ scores can aid in identifying patients who may benefit from further heart failure evaluation.