Diagnostic Yield from Screening and Health Status Burden of Outpatients at Risk for Heart Failure
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Background
Heart failure (HF) is frequently underrecognized in primary care due to nonspecific symptoms and limited screening, resulting in many patients presenting with severely compromised health status (symptoms, functional ability, and quality of life) at the time of diagnosis.
Objectives
To evaluate the diagnostic yield of screening outpatients at risk for HF using a noninvasive assessment of left ventricular end-diastolic pressure (LVEDP) and to describe the health status of patients newly identified with elevated LVEDP.
Methods
A convenience sample of adults with diabetes mellitus (DM), chronic kidney disease (CKD), or suspected HF were screened at three primary care clinics using the Vivio System to identify patients with LVEDP >18 mmHg (positive screening). Among patients with a positive screening result, their health status was evaluated using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score.
Results
Among 2040 screened patients (mean age 74±8 years; 49.8% women; 64.6% with DM; and 34.9% with CKD) 38.5% had an elevated LVEDP. Older patients, women, and those with CKD were more likely to have an elevated LVEDP (p<0.01 for all). Of 653 KCCQ-OS scores collected (mean 85±20), 31.4% had a KCCQ-OS of 100 (asymptomatic), and 26.5% had a KCCQ-OS <80, consistent with NYHA class II-IV.
Conclusion
Nearly 40% of patients had a positive screening, and over two-thirds reported significant health status impairments. Combining the KCCQ with noninvasive LVEDP assessment can identify patients who may require further HF evaluation. Future studies can assess the impact of these strategies on patients’ subsequent health status and clinical events.
