The Tip of the Iceberg: Finding Patients with Heart Failure with Preserved Ejection Fraction in Primary Care

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is under-identified in primary care.

Aim: The aim of this study was to determine what information is available in patients’ primary care practice records that would identify patients with HFpEF.

Design and Setting: Record review in two practices in East of England. Methods: Practices completed a case report form on each patient on the heart failure register and sent anonymised echocardiography reports on patients with an ejection fraction (EF) > 50%. Reports were reviewed and data analysed using SPSS.

Results: 148 patients on the HF Registers with mean age 77 + 12 years were reviewed. Fifty-three patients (36%) had possible HFpEF based on available information. These patients were older and multi-morbid, including high prevalence of overweight and obesity. Confirmation of diagnosis was not possible as recommended HFpEF diagnostic information (natriuretic peptides, echocardiogram parameters of structural heart disease and diastolic function) was widely inconsistent or absent in these patients.

Conclusion: Without correct identification of HFpEF, patient management may be sub-optimal or inappropriate, and lack the needed focus on comorbidities and lifestyle that can improve patient outcomes. We have described in detail the characteristics of many of the patients who probably have HFpEF in a real-world sample, and the improvements and diagnostic information required to better identify them. Identifying more than the tip of the iceberg that is the HFpEF population will allow us to improve the quality of their management, prevent ineffective healthcare and recruit patients into research.