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Screening for Undiagnosed Heart Failure: A Viewpoint
João Pedro Ferreira1, Faiez Zannad2
1Centre d'Investigations Cliniques Plurithématique, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre-lès-Nancy & F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; UnIC@RISE, Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto & Heart Failure Clinic, Internal Medicine Department, Unidade Local de Saude de Gaia/Espinho, Portugal.
Insights
Many heart failure (HF) patients are misdiagnosed due to comorbidities or lack of symptoms, leading to undertreatment. This study proposes a simplified approach for earlier HF diagnosis and intervention.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Heart failure (HF) diagnosis traditionally relies on signs, symptoms, cardiac changes, and natriuretic peptide levels.
- Asymptomatic individuals or those with comorbidities may be misclassified as having 'pre-HF' or undiagnosed HF.
- Comorbidities can mask HF symptoms and affect natriuretic peptide measurements, complicating diagnosis.
Purpose of the Study:
- To address the challenges in early heart failure diagnosis, particularly in patients with comorbidities or subtle symptoms.
- To propose a pragmatic and inclusive strategy for the early identification and management of heart failure.
- To highlight the implications of HF misdiagnosis, leading to potential undertreatment.
Main Methods:
- Analysis of data from studies like HOMAGE (Heart Omics in AGEing) and ALDO-DHF.
- Comparison of patient characteristics between asymptomatic individuals with mild natriuretic peptide elevation and symptomatic HF patients.
- Review of diagnostic criteria and the impact of comorbidities on HF presentation.
Main Results:
- HOMAGE participants with mild natriuretic peptide elevation shared characteristics with symptomatic HF patients from ALDO-DHF.
- The study suggests that asymptomatic individuals may have undiagnosed HF masked by comorbidities or lack of exercise.
- Misdiagnosis can lead to significant undertreatment of heart failure.
Conclusions:
- A simplified, inclusive approach is needed for early heart failure diagnosis.
- Early and accurate HF diagnosis is crucial to prevent undertreatment.
- Integrating assessment of cardiac-renal and metabolic conditions may improve HF detection.
Abstract:
The syndrome of heart failure (HF) is characterized by a triad of (1) signs and symptoms, (2) cardiac alterations, and (3) natriuretic peptide elevation. Patients who exhibit alterations of cardiac structure or function without overt signs or symptoms of HF are staged as having "pre-HF." However, many people with undiagnosed HF walk little and do not exercise; thus, they may be classified as having asymptomatic "pre-HF" simply because they never exercise enough to feel breathless. Moreover, many patients have comorbidities such as chronic obstructive pulmonary disease or obesity and the physical limitations may be attributed to the comorbidities rather than to HF. Such comorbidities may also influence natriuretic peptide measurements. The potential implications of an HF misdiagnosis are that many patients may remain undertreated. This is illustrated with data from the HOMAGE (Heart Omics in AGEing) study, which included asymptomatic people with mild natriuretic peptide elevation. When comparing patient characteristics, HOMAGE participants were similar to those of ALDO-DHF (Effect of Spironolactone on Diastolic Function and Exercise Capacity in Patients with Heart Failure with Preserved Ejection Fraction) who were classified as symptomatic patients with HF. Given the confluence of HF with several cardiac-renal and metabolic conditions, we propose a simplified, pragmatic, and inclusive approach for early HF diagnosis and treatment.
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