Detection of heart failure in a general population not aware of having the disease.

Abstract

Background: Heart failure (HF) is one of the most common causes of hospitalization and death worldwide. We aimed at identifying variables that can be helpful for early diagnosis of HF in primary care.

Methods: In 2015-16, we included 2007 participants aged ≥ 40 years in the 7th Tromsø study. They underwent echocardiography and other examinations needed for establishing a diagnosis of HF according to European guidelines from 2016. We analyzed associations with HF among the 1863 participants who reported not to have HF. Variables significantly associated with HF were included in multivariable logistic regression analyses. Diagnostic models were further analyzed by ROC curves and areas under curve (AUC) were calculated, optimism corrected by bootstrapping.

Results: The HF prevalence in the age groups 40-64 years, 65-74 years, and ≥ 75 years were 3.5%, 11.7% and 29.4%, respectively. A predictive model based on self-reported hypertension, myocardial infarction, atrial fibrillation, body-mass index and moderate to severe dyspnea had an AUC of 0.813 (95% CI 0.785-0.843). In a significantly stronger model, in which NT-proBNP was included and self-reported atrial fibrillation was replaced by atrial fibrillation on ECG, an AUC of 0.849 (95% CI 0.821-0.880) was reached.

Conclusion: Easily available clinical information may be used both to rule out HF an to identify patients needing further examinations. A direct referral to echocardiography should be considered for elderly patients in primary care with a known cardiovascular disease and severe shortness of breath. With less abundant history and symptoms, ECG and NT-proBNP can guide further investigations.