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Undetected Heart Failure in Cardiology: Prevalence, Characteristics, and Outcome
Laurève Chollet1,2,3, Klara Rumora1,2,4, Koray Durak1,2
1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
Undetected heart failure (HF) is prevalent in cardiology patients, with one in three experiencing it. This undiagnosed condition significantly increases the risk of cardiovascular death and acute heart failure hospitalizations.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Recent pilot studies suggested high rates of undiagnosed heart failure (HF) in cardiology patients.
- Confirmation or refutation of these findings is crucial for clinical practice.
Purpose of the Study:
- To determine the prevalence, characteristics, and outcomes of undetected HF in patients undergoing coronary artery disease (CAD) work-up.
- To assess the association between undetected HF and adverse cardiovascular events.
Main Methods:
- A prospective cohort study of 1738 patients referred for non-invasive CAD work-up using cardiac positron emission tomography computed tomography.
- Heart failure (HF) diagnosis and phenotype were adjudicated by an independent cardiologist based on symptoms, natriuretic peptides, and cardiac abnormalities.
- The primary endpoint was a composite of cardiovascular death and acute HF hospitalization over a 2-year follow-up period.
Main Results:
- Among 1600 patients without known HF, 33.4% had adjudicated undetected HF.
- The ratio of undetected HF to known HF was 3.9:1.
- Undetected HF was linked to a significantly increased risk of cardiovascular death and acute HF hospitalization (aHR 7.37).
Conclusions:
- Approximately one-third of patients evaluated for CAD have undetected heart failure.
- Undetected HF is a significant risk factor for adverse cardiovascular outcomes, including death and hospitalization.
Aim:
To confirm or refute recent pilot studies showing unexpectedly high rates of undetected heart failure (HF) in cardiology patients.
Methods:
We assessed the prevalence, characteristics, and outcome of undetected HF in a large prospective cohort study of patients referred for non-invasive coronary artery disease (CAD) work-up with cardiac positron emission tomography computed tomography. HF presence and phenotype were centrally adjudicated by an independent cardiologist according to clinical practice guidelines requiring three mandatory criteria: symptoms, elevated natriuretic peptides, and structural/functional cardiac abnormalities. The endpoint was a composite of cardiovascular death and acute HF (AHF) hospitalization through 2-year of follow-up.
Results:
Among 1738 eligible patients (median age 67 years, 30% women), 138 patients (7.9%) had known HF, and 534 of 1600 patients (33.4%) without known HF had adjudicated undetected HF, resulting in a ratio of undetected HF to known HF of 3.9 (95%CI, 3.2-4.7)-to-1 and a number needed to screen to detect one patient with undetected HF of 3.0 (95%CI, 2.9-3.1). In undetected HF, left ventricular ejection fraction (LVEF) was preserved in 72.3%, mildly reduced in 16%, and reduced in 11.7%. Older age, known CAD, atrial fibrillation, previous pacemaker implantation, and ECG abnormalities were associated with a higher likelihood for undetected HF. Undetected HF was associated with an increased cumulative incidence of the composite endpoint (adjusted subdistribution hazard ratio 7.37 [95%CI, 3.87-14.06], p<0.001, versus no HF).
Conclusion:
One-out-of three patients referred for CAD work-up had undetected HF, which was associated with cardiovascular death and AHF hospitalization.
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