Objectives To characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm.
Methods This is an observational study of prospectively collected data in the Sheffield HEArt Failure registry of consecutive patients with suspected HF between April 2012 and January 2020. Outcome was defined as all-cause mortality.
Results 6144 patients were enrolled: 71% had HF and 29% had no HF. Patients with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) >2000 pg/mL were more likely to have HF than those with NT-proBNP of 400–2000 pg/mL (92% vs 64%, respectively). Frequency of HF phenotypes include: HF with preserved ejection fraction (HFpEF) (33%), HF with reduced ejection fraction (HFrEF) (29%), HF due to valvular heart disease (4%), HF due to pulmonary hypertension (5%) and HF due to right ventricular systolic dysfunction (1%). There were 1485 (24%) deaths over a maximum follow-up of 6 years. The death rate was higher in HF versus no HF (11.49 vs 7.29 per 100 patient-years follow-up, p<0.0001). Patients with HF and an NT-proBNP >2000 pg/mL had lower survival than those with NT-proBNP 400–2000 pg/mL (3.8 years vs 5 years, p<0.0001). Propensity matched survival curves were comparable between HFpEF and HFrEF (p=0.88).
Conclusion Our findings support the use by NICE’s HF diagnostic algorithm of tiered triage of patients with suspected HF based on their NT-proBNP levels. The two pathways yielded distinctive groups of patients with varied diagnoses and prognosis. HFpEF is the most frequent diagnosis, with its challenges of poor prognosis and paucity of therapeutic options.
- heart failure
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Twitter @HosamAssadi, @AAlMohammad87
Contributors PG and AA-M conceptualised and organised the study. GF, NL, DR, AC and AA-M facilitated data collection. AJS and PG did all the statistical analyses. AJS facilitated the ethical approval. HA, UN and AD helped draft the initial manuscript. PG drafted and revised figures and tables. AA-M and PG provided critical input into the content and discussion regarding the findings of the study. All authors took part in critical review and drafting of the manuscript, and have read and approved the final manuscript.
Funding AJS is supported by Wellcome Trust (AS: 205188/Z/16/Z). PG is supported by the Academy of Sciences Starter Grant (PG: SGL018/1100).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Sheffield HEArt Failure registry (SHEAF registry) has been sanctioned by the local 3D-lab committee under the registration number 222349P4. This has the appropriate research ethics committee approval (17/YH/0142). This study complies with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information.
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