Tool may allow earlier detection of heart failure in the community
A tool based on three symptoms, with follow-up testing, was successfully used to detect heart failure, as well as undiagnosed atrial fibrillation, at community events in areas of socioeconomic deprivation, a British study found.
Earlier detection of heart failure (HF) was feasible at community heart health awareness events, a study found.
Researchers assessed BEAT-HF (Breathless, Exhausted, Ankle swelling, Time for a point of care NT-proBNP test) at 12 community events from February to September 2024 in nine cities across the United Kingdom. People ages 40 years and older were invited by social media, primary care or hospital teams, local councils, and host venues. HF symptoms were analyzed with the use of BEAT-HF questions, and clinical checks included 30-second single-lead electrocardiography and blood pressure (BP). Medtronic and LumiraDx provided support for the project. The study was published March 12 as a research letter in JACC: Heart Failure.
A total of 5,373 people were assessed (mean age, 62.9; 54% women; 13% minorities; two-thirds from areas of highest deprivation). Among the cohort, 1,451 (27%) had known hypertension and 1,710 (32%) had elevated BP on the day of assessment, including 1,044 (19%) who were not known to have hypertension. Seven percent had diabetes, and 24% had hypercholesterolemia. Atrial fibrillation (AF) was newly diagnosed in 113 (2.1%); 12 people had a known diagnosis of AF. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were tested in 743 (13.8%) of the 5,373 attendees based on presence of any one of the BEAT symptoms. A total of 70 patients (9.5%) had an elevated NT-proBNP level of at least 400 ng/L, and 178 (24%) had an NT-proBNP level of 125 to 400 ng/L.
Per guidelines, transthoracic echocardiography and specialist review were done in those with NT-proBNP levels of 400g/L or above, and a new diagnosis of HF was confirmed in 64% of these attendees (35% had HF with reduced ejection fraction, 53% had HF with preserved ejection fraction, and 12% had HF with midrange ejection fraction). Cities with greater deprivation had more attendees with elevated BP (35% vs. 20%; P<0.001) and a higher percentage of elevated NT-proBNP levels among symptomatic patients (13.6% vs. 8%; P=0.02). Age, hypertension, AF, and the three BEAT symptoms of breathlessness, exhaustion, and ankle swelling were associated with higher odds of raised NT-proBNP, whereas lipid-lowering treatment was associated with lower odds of raised NT-proBNP.
BEAT-HF symptom methodology can be used as a simple tool to enable HF detection, the authors wrote. Detecting those with milder HF symptoms in a community setting can enable timely diagnosis and initiation of therapy, thereby helping to avert adverse outcomes. People living in deprived areas are “harder to reach,” less engaged with primary care, and more likely to develop HF, particularly at an earlier age, the authors noted.
These results show a need for larger-scale health promotion initiatives centered around the BEAT-HF methodology, they said. “A focus on adults with cardiovascular risk factors at high risk of HF could improve the yield and efficacy of applying the BEAT-HF methodology to enable timely community diagnosis leading to initiation of guideline-recommended treatment for HF (‘BEAT to Treat’).”