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Abdullayev K, Gorvett O, Sochiera A, Laidlaw L, Chico T, Manktelow M, Buckley O, Condell J, Van Arkel R, Diaz V, Matcham F. Stakeholder perspectives on contributors to delayed and inaccurate diagnosis of cardiovascular disease and their implications for digital health technologies: a UK-based qualitative study. BMJ Open 2024; 14:e080445. [PMID: 38772579 PMCID: PMC11110589 DOI: 10.1136/bmjopen-2023-080445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/05/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE The aim of this study is to understand stakeholder experiences of diagnosis of cardiovascular disease (CVD) to support the development of technological solutions that meet current needs. Specifically, we aimed to identify challenges in the process of diagnosing CVD, to identify discrepancies between patient and clinician experiences of CVD diagnosis, and to identify the requirements of future health technology solutions intended to improve CVD diagnosis. DESIGN Semistructured focus groups and one-to-one interviews to generate qualitative data that were subjected to thematic analysis. PARTICIPANTS UK-based individuals (N=32) with lived experience of diagnosis of CVD (n=23) and clinicians with experience in diagnosing CVD (n=9). RESULTS We identified four key themes related to delayed or inaccurate diagnosis of CVD: symptom interpretation, patient characteristics, patient-clinician interactions and systemic challenges. Subthemes from each are discussed in depth. Challenges related to time and communication were greatest for both stakeholder groups; however, there were differences in other areas, for example, patient experiences highlighted difficulties with the psychological aspects of diagnosis and interpreting ambiguous symptoms, while clinicians emphasised the role of individual patient differences and the lack of rapport in contributing to delays or inaccurate diagnosis. CONCLUSIONS Our findings highlight key considerations when developing digital technologies that seek to improve the efficiency and accuracy of diagnosis of CVD.
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Affiliation(s)
| | | | - Anna Sochiera
- School of Psychology, University of Sussex, Falmer, UK
| | - Lynn Laidlaw
- Honorary Fellow, College of Health, Wellbeing and Life Sciences, Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK
| | - Timothy Chico
- Clinical Medicine, School of Medicine and Population Health, The Medical School, The University of Sheffield, Sheffield, UK
| | - Matthew Manktelow
- Centre for Personalised Medicine, Ulster University Faculty of Life and Health Sciences, Londonderry, UK
| | - Oliver Buckley
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - Joan Condell
- Centre for Personalised Medicine, Ulster University Faculty of Life and Health Sciences, Londonderry, UK
| | | | - Vanessa Diaz
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Falmer, UK
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Graul EL, Nordon C, Rhodes K, Menon S, Al Ammouri M, Kallis C, Ioannides AE, Whittaker HR, Peters NS, Quint JK. Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study. BMC Pulm Med 2024; 24:221. [PMID: 38704538 PMCID: PMC11069200 DOI: 10.1186/s12890-024-03035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND An immediate, temporal risk of heart failure and arrhythmias after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation has been demonstrated, particularly in the first month post-exacerbation. However, the clinical profile of patients who develop heart failure (HF) or atrial fibrillation/flutter (AF) following exacerbation is unclear. Therefore we examined factors associated with people being hospitalized for HF or AF, respectively, following a COPD exacerbation. METHODS We conducted two nested case-control studies, using primary care electronic healthcare records from the Clinical Practice Research Datalink Aurum linked to Hospital Episode Statistics, Office for National Statistics for mortality, and socioeconomic data (2014-2020). Cases had hospitalization for HF or AF within 30 days of a COPD exacerbation, with controls matched by GP practice (HF 2:1;AF 3:1). We used conditional logistic regression to explore demographic and clinical factors associated with HF and AF hospitalization. RESULTS Odds of HF hospitalization (1,569 cases, 3,138 controls) increased with age, type II diabetes, obesity, HF and arrhythmia history, exacerbation severity (hospitalization), most cardiovascular medications, GOLD airflow obstruction, MRC dyspnea score, and chronic kidney disease. Strongest associations were for severe exacerbations (adjusted odds ratio (aOR)=6.25, 95%CI 5.10-7.66), prior HF (aOR=2.57, 95%CI 1.73-3.83), age≥80 years (aOR=2.41, 95%CI 1.88-3.09), and prior diuretics prescription (aOR=2.81, 95%CI 2.29-3.45). Odds of AF hospitalization (841 cases, 2,523 controls) increased with age, male sex, severe exacerbation, arrhythmia and pulmonary hypertension history and most cardiovascular medications. Strongest associations were for severe exacerbations (aOR=5.78, 95%CI 4.45-7.50), age≥80 years (aOR=3.15, 95%CI 2.26-4.40), arrhythmia (aOR=3.55, 95%CI 2.53-4.98), pulmonary hypertension (aOR=3.05, 95%CI 1.21-7.68), and prescription of anticoagulants (aOR=3.81, 95%CI 2.57-5.64), positive inotropes (aOR=2.29, 95%CI 1.41-3.74) and anti-arrhythmic drugs (aOR=2.14, 95%CI 1.10-4.15). CONCLUSIONS Cardiopulmonary factors were associated with hospitalization for HF in the 30 days following a COPD exacerbation, while only cardiovascular-related factors and exacerbation severity were associated with AF hospitalization. Understanding factors will help target people for prevention.
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Affiliation(s)
- Emily L Graul
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Clementine Nordon
- Biopharmaceuticals Medical, AstraZeneca, Academy House, 136 Hills Rd, Cambridge, CB2 8PA, UK
| | - Kirsty Rhodes
- Biopharmaceuticals Medical, AstraZeneca, Academy House, 136 Hills Rd, Cambridge, CB2 8PA, UK
| | - Shruti Menon
- Medical and Scientific Affairs, AstraZeneca, 2 Pancras Sq, London, N1C 4AG, UK
| | - Mahmoud Al Ammouri
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Constantinos Kallis
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Anne E Ioannides
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Hannah R Whittaker
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK
| | - Jennifer K Quint
- School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK.
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3
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Lam CSP, Harding E, Bains M, Chin A, Kanumilli N, Petrie MC, Pohja-Hutchison P, Yang J, Butler J. Identification of urgent gaps in public and policymaker knowledge of heart failure: Results of a global survey. BMC Public Health 2023; 23:1023. [PMID: 37254075 DOI: 10.1186/s12889-023-15405-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Despite advances in the treatment of heart failure (HF) with reduced ejection fraction, people with HF continue to have a high risk of mortality and hospitalisation. Patients also suffer from poor quality of life, with reduced societal and economic participation. The burden of HF on patients and healthcare systems is extraordinary, yet awareness remains low. This survey was conducted to identify gaps in general public and policymaker knowledge around HF. METHODS A closed-question web-based survey of the general public and policymakers was conducted between February and October 2020. Study outcomes assessed the participants' awareness and understanding of HF symptoms, risk factors and mortality, and views around hospital admissions in their country. Responses were collected using multiple-choice questions. RESULTS The survey was completed by 26,272 general public respondents in 13 countries and 281 government and public sector policymakers in nine countries. While 99% of general public respondents had heard of HF, their understanding of the condition and its symptoms was poor, and only 6% identified that shortness of breath, fatigue, and leg swelling were the main symptoms of HF. Of policymaker respondents, 14% identified HF as the leading cause of avoidable hospitalisations, and only 4% recognised that ~ 87% of government spending on HF is related to hospitalisations. CONCLUSIONS Major gaps were identified in the understanding of HF and the burden it places on patients and their caregivers, healthcare systems and society. This study confirms an ongoing need for national policy strategies and investment to raise awareness of the importance of HF prevention, early diagnosis, and implementation of effective treatments to reduce hospitalisations and death.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore, Duke-NUS Medical School, 169857, Singapore, Singapore.
| | - Ed Harding
- The Health Policy Partnership, WC2N 4JS, London, UK
| | - Marc Bains
- The HeartLife Foundation, V5X 1E7, Vancouver, BC, Canada
| | - Alex Chin
- AstraZeneca, Global Medical Affairs, 20878, Gaithersburg, MD, USA
| | | | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, The University Court of the University of Glasgow, G12 8QQ, Glasgow, UK
| | | | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology China, 100730, Beijing, China
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 39216, Jackson, MS, USA.
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Charman SJ, Okwose NC, Taylor CJ, Bailey K, Fuat A, Ristic A, Mant J, Deaton C, Seferovic PM, Coats AJS, Hobbs FDR, MacGowan GA, Jakovljevic DG. Feasibility of the cardiac output response to stress test in suspected heart failure patients. Fam Pract 2022; 39:805-812. [PMID: 35083480 PMCID: PMC9508869 DOI: 10.1093/fampra/cmab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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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Affiliation(s)
- Sarah J Charman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Clare J Taylor
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Kristian Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ahmet Fuat
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust & School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
| | - Arsen Ristic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Petar M Seferovic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - F D Richard Hobbs
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Guy A MacGowan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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5
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Roalfe AK, Lay-Flurrie SL, Ordóñez-Mena JM, Goyder CR, Jones NR, Hobbs FDR, Taylor CJ. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study. Eur Heart J 2021; 43:ehab781. [PMID: 34849715 PMCID: PMC8885323 DOI: 10.1093/eurheartj/ehab781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/23/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Heart failure (HF) is a malignant condition with poor outcomes and is often diagnosed on emergency hospital admission. Natriuretic peptide (NP) testing in primary care is recommended in international guidelines to facilitate timely diagnosis. We aimed to report contemporary trends in NP testing and subsequent HF diagnosis rates over time. METHODS AND RESULTS Cohort study using linked primary and secondary care data of adult (≥45 years) patients in England 2004-18 (n = 7 212 013, 48% male) to report trends in NP testing (over time, by age, sex, ethnicity, and socioeconomic status) and HF diagnosis rates. NP test rates increased from 0.25 per 1000 person-years [95% confidence interval (CI) 0.23-0.26] in 2004 to 16.88 per 1000 person-years (95% CI 16.73-17.03) in 2018, with a significant upward trend in 2010 following publication of national HF guidance. Women and different ethnic groups had similar test rates, and there was more NP testing in older and more socially deprived groups as expected. The HF detection rate was constant over the study period (around 10%) and the proportion of patients without NP testing prior to diagnosis remained high [99.6% (n = 13 484) in 2004 vs. 76.7% (n = 12 978) in 2017]. CONCLUSION NP testing in primary care has increased over time, with no evidence of significant inequalities, but most patients with HF still do not have an NP test recorded prior to diagnosis. More NP testing in primary care may be needed to prevent hospitalization and facilitate HF diagnosis at an earlier, more treatable stage.
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Affiliation(s)
- Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - Sarah L Lay-Flurrie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - Clare R Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford OX2 6GG, UK
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6
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FASTer diagnosis: Time to BEAT heart failure. BJGP Open 2021; 5:BJGPO.2021.0006. [PMID: 33906895 PMCID: PMC8278515 DOI: 10.3399/bjgpo.2021.0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
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Ferreira JP, Kraus S, Mitchell S, Perel P, Piñeiro D, Chioncel O, Colque R, de Boer RA, Gomez-Mesa JE, Grancelli H, Lam CSP, Martinez-Rubio A, McMurray JJV, Mebazaa A, Panjrath G, Piña IL, Sani M, Sim D, Walsh M, Yancy C, Zannad F, Sliwa K. World Heart Federation Roadmap for Heart Failure. Glob Heart 2020; 14:197-214. [PMID: 31451235 DOI: 10.1016/j.gheart.2019.07.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- João Pedro Ferreira
- National Institute of Health and Medical Research, Center for Clinical Multidisciplinary Research, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Sarah Kraus
- Groote Schuur Hospital and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Pablo Perel
- London School of Tropical Hygiene and Medicine, London, United Kingdom
| | - Daniel Piñeiro
- Division of Medicine, Hospital de Clínicas Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases "C.C. Iliescu" Bucharest, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Roberto Colque
- Coronary Care Unit, Sanatorio Allende Cerro, Cordoba, Argentina
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Hugo Grancelli
- Cardiology Department, Sanatorio Trinidad Palermo, Buenos Aires, Argentina
| | | | - Antoni Martinez-Rubio
- Department of Cardiology, University Hospital Sabadell Autonomous, University of Barcelona, Barcelona, Spain
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; U942 MASCOT (cardiovascular MArkers in Stress COndiTions), National Institute of Health and Medical Research, France; Department of Anesthesia, Burn, Intensive Care, Saint Louis Lariboisière Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gurusher Panjrath
- Department of Medicine /Cardiology, George Washington University School of Medicine, George Washington University, Washington, DC, USA
| | - Ileana L Piña
- Wayne State University, Michigan, USA; Wayne State University, Michigan, USA
| | - Mahmoud Sani
- Department of Medicine, Bayero University Kano, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Kano, Nigeria
| | - David Sim
- Department of Cardiology, Heart Failure Program at the National Heart Center Singapore, Singapore
| | - Mary Walsh
- Department of Heart Failure and Cardiac Transplantation, St. Vincent Heart Center, Indianapolis, IN, USA
| | - Clyde Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faiez Zannad
- Department of Cardiology, Centre d'Investigation Clinique (CIC), Centre Hospitalier Universitaire, University Henri Poincaré, Nancy, France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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Goyder CR, Roalfe AK, Jones NR, Taylor KS, Plumptre CD, Fanshawe TR, Hobbs FDR, Taylor CJ. Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15536.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Patients diagnosed with heart failure in primary care have a better prognosis than those diagnosed in hospital. However, most cases are missed in the community. Recent attention has focussed on the potential of early detection through screening. Natriuretic peptides (NPs) are tested by GPs and used to rule out heart failure in patients presenting with symptoms. Evidence is now emerging that they may also have a role in screening but their accuracy in this context and the associated optimal thresholds, have not been established. The impact that NP screening would have on patients and health care systems also remains unclear. Methods: We aim to undertake a systematic search of the following sources: Ovid Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Screening, data extraction and critical appraisal will be carried out independently and in duplicate by two reviewers. We will include studies based in the community with >100 participants that recruited a screened population. We will not add a study design filter and there will be no language restriction. The primary outcome will be the sensitivity and the specificity of NP screening and optimal thresholds for screening will be explored. Outcomes of interest for the impact analysis will include mortality, hospital admissions and cost effectiveness. This protocol has been developed in accordance with guidelines from the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Discussion: This systematic review will identify how accurately NP screen for heart failure in the community and explore where NP screening thresholds should be set. It also aims to summarise the clinical impact of this strategy. Together, these results should inform future interventions that may provide an alternative pathway to facilitate improved detection of heart failure in the community. Registration: PROSPERO CRD42018087498; registered on 11 May 2018.
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9
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Goyder CR, Roalfe AK, Jones NR, Taylor KS, Plumptre CD, Hobbs FDR, Taylor CJ. Diagnostic accuracy and clinical impact of natriuretic peptide screening for the detection of heart failure in the community: a protocol for systematic review and meta-analysis. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15536.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Patients diagnosed with heart failure in primary care have a better prognosis than those diagnosed in hospital. However, most cases are missed in the community. Recent attention has focussed on the potential of early detection through screening. Natriuretic peptides (NPs) are tested by GPs and used to rule out heart failure in patients presenting with symptoms. Evidence is now emerging that they may also have a role in screening but their accuracy in this context and the associated optimal thresholds, have not been established. The impact that NP screening would have on patients and health care systems also remains unclear. Methods: We aim to undertake a systematic search of the following sources: Ovid Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Screening, data extraction and critical appraisal will be carried out independently and in duplicate by two reviewers. We will include studies based in the community with >100 participants that recruited a screened population. We will not add a study design filter and there will be no language restriction. The primary outcome will be the sensitivity and the specificity of NP screening and optimal thresholds for screening will be explored. Outcomes of interest for the impact analysis will include mortality, hospital admissions and cost effectiveness. This protocol has been developed in accordance with guidelines from the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P). Discussion: This systematic review will identify how accurately NP screen for heart failure in the community and explore where NP screening thresholds should be set. It also aims to summarise the clinical impact of this strategy. Together, these results should inform future interventions that may provide an alternative pathway to facilitate improved detection of heart failure in the community. Registration: PROSPERO CRD42018087498; registered on 11 May 2018.
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10
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Otto CM. Heartbeat: Primary care delays in heart failure diagnosis. BRITISH HEART JOURNAL 2019; 105:661-662. [DOI: 10.1136/heartjnl-2019-315117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Bell-Davies F, Goyder C, Gale N, Hobbs FDR, Taylor CJ. The role of informal carers in the diagnostic process of heart failure: a secondary qualitative analysis. BMC Cardiovasc Disord 2019; 19:92. [PMID: 31014239 PMCID: PMC6480764 DOI: 10.1186/s12872-019-1075-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Heart failure (HF) is a common clinical syndrome, particularly in older people, and symptoms can develop gradually. The aim of this study was to explore the role of informal carers in the HF diagnostic process. Methods Secondary analysis of qualitative interviews with 16 participants with a new diagnosis of HF. Original interviews were conducted in the participant’s home, with carers present in some cases. Interview transcripts were re-analysed using the Framework Method for themes pertaining to informal carers and how they were involved in the diagnostic process. Results Informal carers often noticed symptoms, such as breathlessness, before participants. In some cases, carers colluded with participants in normalising symptoms but over time, when symptoms failed to resolve or got worse, they encouraged participants to seek medical help. Adult children of participants commonly initiated help-seeking behaviour. During the diagnostic process, carers coordinated participants’ healthcare through advocacy and organisation. Carers were keen to be informed about the diagnosis, but both participants and carers struggled to understand some aspects of the term ‘heart failure’. Conclusions Carers play a crucial role in HF diagnosis, particularly in initiating contact with healthcare services, and should be empowered to encourage people with HF symptoms to seek medical help. Improving public awareness of HF could mean informal carers are more likely to notice symptoms. The important role of carers in supporting the patient’s route to diagnosis should be incorporated into future care pathways and explored in further research.
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Affiliation(s)
- Frances Bell-Davies
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Nicola Gale
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
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