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Post-COVID-19 era heart failure diagnosis and outcomes: adherence to National Institute for Health and Care

Usmaan B Razzaq1, Kieran F Docherty1,2, Alhussain Al Ajmi1

  • 1School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.

Open Heart
|January 9, 2026
PubMed

Insights

Adherence to NICE guidelines for heart failure (HF) diagnosis is low, with few patients receiving timely echocardiograms despite high natriuretic peptide (NP) levels indicating increased mortality risk.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Diagnostic Pathways

Background:

  • Heart failure (HF) is a prevalent condition associated with significant morbidity and mortality.
  • UK National Institute for Health and Clinical Excellence (NICE) guidelines recommend prioritizing natriuretic peptide (NP) level assessment for HF diagnosis.
  • Guidelines suggest urgent echocardiogram (within 2 weeks) for patients with high NP levels (NT-proBNP >2000 ng/L).

Purpose of the Study:

  • To evaluate adherence to NICE guidelines for HF diagnostic pathways in the post-COVID-19 era.
  • To assess the timeliness of echocardiogram referrals based on natriuretic peptide (NP) levels.
  • To analyze the association between NP levels, diagnostic outcomes, and 1-year mortality.

Main Methods:

  • Retrospective audit of 899 consecutive referrals to a HF diagnostic pathway across seven hospitals (Jan-June 2022).
  • Patients categorized by NT-proBNP levels: 400-2000 ng/L (echocardiogram within 6 weeks) or >2000 ng/L (echocardiogram within 2 weeks).
  • Recorded time-to-echocardiogram and obtained 1-year outcomes (HF hospitalization, death) from electronic records.

Main Results:

  • Only 8% of patients in both NT-proBNP categories received echocardiograms within recommended NICE timeframes.
  • 28% of patients were diagnosed with HF; diagnosis rates were higher in the NT-proBNP >2000 ng/L group (42% vs 22%).
  • One-year mortality was 12%, significantly higher in the NT-proBNP >2000 ng/L group (21% vs 9%).

Conclusions:

  • High natriuretic peptide (NP) levels identify a high-risk HF population with increased mortality.
  • There is a significant gap in adherence to NICE guideline-recommended echocardiogram timelines for HF diagnosis.
  • Urgent investigation of patients with high NP levels is crucial, comparable to suspected cancer referrals.
Abstract

Keywords:
COVID-19Diagnostic ImagingHEART FAILURE

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