Screening for Undiagnosed Heart Failure: A Viewpoint.

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.