A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

Charman, Sarah J; Okwose, Nduka; Stefanetti, Renae J.; Bailey, Kristian; Skinner, Jane; Ristić, Arsen; Seferović, Petar; Scott, Mike; Turley, Stephen D.; Fuat, Ahmet; Mant, Jonathan; MacGowan, Guy A.; Jakovljevic, Djordje G.

doi:10.1002/ehf2.12302

Cited by 10 publications

(9 citation statements)

References 31 publications

(55 reference statements)

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“… 26 It uses continuous haemodynamic measurements based on noninvasive, electrical signal processing bioreactance technology (NICOM, Cheetah Medical, Inc., MA, USA), which we have previously validated. 28–30 The CORS test has demonstrated acceptable reproducibility in healthy adults (≥50 years old) 26 and consists of 4 phases: (i) rest (patients lies in the supine position for 3 min); (ii) challenge (patients remains in the standing position for 3 min); (iii) and (iv) stress-step exercise (patient completes a step test on a 15-inch step board with intensity controlled by a metronome at 10 and 15 steps per min). 26 Due to time restrictions in the clinic, patients in this study only completed 1 stress-step exercise phase at the 15 steps per min intensity.…”

Section: Methodsmentioning

confidence: 99%

“…The COVID-19 pandemic has further reinforced that new strategies to achieve timely diagnosis due to patients avoiding urgent care for HF signs and symptoms 23 , 24 in primary care should be a priority for future research and policy as most recently suggested. 25 To help mitigate this challenge, we have developed and recently confirmed acceptable reproducibility of a novel, easy-to-administer, noninvasive cardiac output response to stress (CORS) test 26 ( Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of the cardiac output response to stress test in suspected heart failure patients

et al. 2022

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Background Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. Objectives (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. Methods Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. Results A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. Conclusion The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of the cardiac output response to stress test in suspected heart failure patients

et al. 2022

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“…The CORS test (figure 2) has been previously described16 and consists of four phases: (1) rest, where the patient lies in the supine position for 3 min; (2) challenge, where the patient remains in the standing position for 3 min; (3) and (4) stress exercise, where a patient completes a step test with continuous haemodynamic measurements (ie, cardiac output and cardiac index) using non-invasive, electrical signal processing technology.…”

Section: Methodsmentioning

confidence: 99%

“…We have recently developed and confirmed acceptable reproducibility of a novel, easy-to-use, non-invasive cardiac output response to stress (CORS) test (figure 2) for the evaluation of cardiac function in primary care 16. The CORS test has the potential to be used by healthcare professionals to improve diagnostic accuracy for suspected HF and provide an objective measure of cardiac function as a ‘rule in’ test.…”

Section: Introductionmentioning

confidence: 93%

Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

et al. 2019

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ObjectiveTo explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care.DesignQualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach.SettingNewcastle upon Tyne, UK.ParticipantsFourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists).ResultsFour themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices.ConclusionThe development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.

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“…During a cardiac exercise stress test, the patient walks on a treadmill or cycles to increase the heart rate and make the heart work progressively harder [26,27]. Normal vital signs are monitored, and the symptoms of fatigue and chest discomfort are assessed.…”

Section: Physical Measures Of Fatiguementioning

confidence: 99%

Using the NIH symptom science model to understand fatigue and mitochondrial bioenergetics

Shen

Mahoney

Peltzer

et al. 2020

J Nurs

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The symptom of fatigue is prevalent among patients with chronic diseases and conditions such as congestive heart failure and cancer. It has a significant debilitating impact on patients' physical health, quality of life, and well-being. Early detection and appropriate assessment of fatigue is essential for diagnosing, treating, and monitoring disease progression. However, it is often challenging to manage the symptom of fatigue without first investigating the underlying biological mechanisms. In this narrative review, we conceptualize the symptom of fatigue and its relationship with mitochondrial bioenergetics using the National Institute of Health Symptom Science Model (NIH-SSM). In particular, we discuss mental and physical measures to assess fatigue, the importance of adenosine triphosphate (ATP) in cellular and organ functions, and how impaired ATP production contributes to fatigue. Specific methods to measure ATP are described. Recommendations are provided concerning how to integrate biological mechanisms with the symptom of fatigue for future research and clinical practice to help alleviate symptoms and improve patients' quality of life.

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A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

Cited by 10 publications

References 31 publications

Feasibility of the cardiac output response to stress test in suspected heart failure patients

Feasibility of the cardiac output response to stress test in suspected heart failure patients

Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study

Using the NIH symptom science model to understand fatigue and mitochondrial bioenergetics

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