Opportunistic screening models for high-risk men and women to detect diastolic dysfunction and heart failure with preserved ejection fraction in the community

Abstract

BackgroundThe prevalence of undetected left ventricular diastolic dysfunction is high, especially in the elderly with comorbidities. Left ventricular diastolic dysfunction is a prognostic indicator of heart failure, in particularly of heart failure with preserved ejection fraction and of future cardiovascular and all-cause mortality. Therefore we aimed to develop sex-specific diagnostic models to enable the early identification of men and women at high-risk of left ventricular diastolic dysfunction with or without symptoms of heart failure who require more aggressive preventative strategies.DesignIndividual patient data from four primary care heart failure-screening studies were analysed (1371 participants, excluding patients classified as heart failure and left ventricular ejection fraction <50%).MethodsEleven candidate predictors were entered into logistic regression models to be associated with the presence of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in men and women separately. Internal-external cross-validation was performed to develop and validate the models.ResultsIncreased age and β-blocker therapy remained as predictors in both the models for men and women. The model for men additionally consisted of increased body mass index, moderate to severe shortness of breath, increased pulse pressure and history of ischaemic heart disease. The models performed moderately and similarly well in men (c-statistics range 0.60–0.75) and women (c-statistics range 0.51–0.76) and the performance improved significantly following the addition of N-terminal pro b-type natriuretic peptide (c-statistics range 0.61–0.80 in women and 0.68–0.80 in men).ConclusionsWe provide an easy-to-use screening tool for use in the community, which can improve the early detection of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in high-risk men and women and optimise tailoring of preventive interventions.

Structural heart disease, cardiac dysfunction and heart failure: the ambiguity of a definition

“…2 For many individuals, there must be a long, preclinical phase of cardiac dysfunction. 3,4 Intervening before the onset of symptoms may offer the best opportunity to delay their onset, change the disease trajectory and prolong active life. This requires screening of asymptomatic people, usually those at greater risk of developing heart failure, to identify preclinical cardiac dysfunction.…”

Metabolic syndrome severity score is associated with diastolic dysfunction and low-grade inflammation in a community-based cohort

“…12 Further research is needed to assess how using a continuous MetS severity score can improve diastolic dysfunction prediction beyond the dichotomous MetS categorization and its individual components, and even be integrated with other screening models for diastolic dysfunction in the community. 13…”

Community screening for heart failure with preserved ejection fraction

“…The tool is designed to facilitate the decision-making process in primary care units. 4 This may be useful as both overdiagnoses and under-diagnoses have been reported. 5,6 The availability of guideline-recommended N-terminal pro-brain natriuretic peptide (NT-pro BNP)/BNP is scarce in primary care units, echocardiography even more so.…”