State-of-the-Art Strategies in Heart Failure Screening

Heart Failure (HF) is a major global health concern affecting approximately 64 million individuals. Because early asymptomatic stages are frequently overlooked, many patients are diagnosed late, after preventable morbidity and hospitalization. Screening that identifies high-risk individuals earlier may enable timely intervention and disease modification.

This narrative review searched PubMed and Embase for English-language literature published between 2018 and 2025 on HF screening. Search themes included heart failure, early detection, screening strategies, natriuretic peptides, biomarkers, echocardiography, cardiac imaging, digital health, wearable technologies, and Artificial Intelligence (AI). Relevant guidelines, clinical studies, meta-analyses, and review articles were evaluated and synthesized with emphasis on diagnostic performance, feasibility, and implementation across different healthcare settings.

Targeted screening of high-risk groups (e.g., hypertensives, diabetics, those with established cardiovascular diseases) was consistently more effective than symptom-based evaluation. Natriuretic peptides (BNP/NT-proBNP) showed high sensitivity for ruling out HF in non-acute settings and for biomarker triage of individuals at increased risk, while echocardiography remained the cornerstone for confirmatory structural and functional assessment. Digital health tools, including wearables and AI-driven algorithms, showed promise for widely applicable risk stratification and remote monitoring, although performance and feasibility varied by setting.

Key gaps include limited prospective outcome-driven trials, heterogeneity of screening thresholds and pathways, disparities in access to biomarkers and imaging, and unresolved issues in data quality, privacy, bias, and workflow integration for digital/AI approaches in practice.

Integrated, stepwise HF screening frameworks that combine risk stratification, biomarker triage, confirmatory imaging, and context-appropriate digital support may facilitate earlier detection and link positive screens to practical preventive and therapeutic care. Future research should prioritize context-adapted pathways and randomized evaluations of patientcentred outcomes and cost-effectiveness.