Is Heart Failure Under-Diagnosed?: Prospective, Clinical Guideline-based, Screening Study in an Elderly Population to Determine Disease Prevalence
Leon Jonker (UoC) and Madhusudhan Varma (NCIC)
Heart failure (HF) is a serious condition affecting the ability of the heart to pump blood around the body. One or both of the ventricles in the heart that are responsible for this job are malfunctioning in HF. Patient symptoms can include shortness of breath, tiredness, and fluid build-up in the legs and/or the lungs. Serious complications may develop, such as damage to other organs such as the kidneys, lung infections, stroke and cardiac arrest. Knowing whether someone has HF is useful because medications can be prescribed to slow down the progression of the disease. Various researchers have flagged up that the number of known HF cases is likely much lower than the actual number of patients who actually have HF; in other words, HF is likely under-diagnosed.
A sample of 292 patients without existing HF diagnosis, and not necessarily obvious symptoms of HF, will be screened for the presence of HF. This will be done in line with existing national clinical guidelines, and the focus will be on patients aged 65 years or older – initial data shows that 80% of HF patients fall into this age bracket. Furthermore, apart from the risk of HF going up with age, these patients are also more likely to have other health conditions that can make the outlook worse (eg diabetes, kidney disease, hypertension). An initial NT-proBNP (N-terminal pro-B-type natriuretic peptide) blood test will be done, measuring the degree of strain the heart is under. If the levels of NT-proBNP are above a certain pre-defined level, patients will undergo a non-invasive transthoracic echocardiogram (aka as an ‘echo’) to check if indeed they have HF. This approach will allow us to say with a degree of certainty if there is an issue with under-diagnosis of HF and – if so – how big this issue may be. Initial local analysis, and data from the scientific literature, indicates that there may be an issue. This project will determine if indeed it is the case.