Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Heart failure with preserved ejection fraction (HFpEF) presents with heart failure symptoms despite normal ejection fraction.
• Current diagnostic pathways in the UK for HFpEF using transthoracic echocardiography (TTE) can lead to delays.
• A need exists for a consistent and practical approach to reporting echocardiographic findings suggestive of HFpEF.

Purpose of the Study:

• To develop and validate a standardized, clinically appropriate, and practical method for reporting echocardiographic suspicion of HFpEF.
• To address disparities in patient pathways and improve the diagnostic process for HFpEF.
• To enhance the consistency of TTE reporting for HFpEF across the UK.

Main Methods:

• The Delphi method was employed with a steering group of nine UK experts to identify key domains and generate consensus statements.
• A survey using a four-point Likert scale was distributed to 135 UK healthcare professionals experienced in HF management.
• Consensus was defined as 75% agreement ('strong') or ≥90% ('very strong').

Main Results:

• 34 consensus statements were generated across seven domains, including system challenges, referral enhancement, and HFpEF etiology.
• 20 statements (59%) achieved very strong agreement, and 10 (29%) achieved strong agreement.
• Participants included physiologists, HF nurses, cardiologists, GPs, and pharmacists, indicating broad professional engagement.

Conclusions:

• Standardized TTE reporting and specialist referral pathways are essential for timely HFpEF diagnosis.
• Eliminating diagnostic delays and geographical disparities requires consistent reporting and multidisciplinary collaboration.
• Improved HFpEF detection rates and patient experience depend on enhanced education and awareness.