Improving Recognition of Heart Failure With Preserved Ejection Fraction in the Outpatient Setting: A Pilot Study of Readily Useful Clinical Attributes

TL;DR

This study identifies clinical indicators that can help detect heart failure with preserved ejection fraction during outpatient visits.

Contribution

The study highlights readily available clinical attributes for early recognition of HFpEF in outpatient settings.

Findings

93.5% of patients had at least one echocardiographic abnormality.

Common comorbidities included hypertension, obesity, diabetes, and chronic kidney disease.

Symptoms like dyspnea and fatigue should prompt early cardiology referral for at-risk patients.

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly acknowledged as a major clinical condition, yet its diverse presentation often hinders prompt diagnosis and management. This study aims to identify clinical variables obtainable during routine outpatient visits that can help in recognizing subclinical and unrecognized HFpEF or those at risk of developing it.

Methods: This retrospective study analyzed patient data from July 2022 to June 2023 at The University Health Truman Medical Center in Kansas City, Missouri, United States. Chart reviews were performed for patients seen in various outpatient clinics, focusing on those presenting with specific symptoms and comorbidities indicative of HFpEF. Data collected included demographics, vital signs, comorbidities, laboratory values, and echocardiographic findings.

Results: A total of 174 patients (mean age 60 ± 11 years) were included. The majority were female (53%) and White patients. Common comorbidities included hypertension, obesity, diabetes, and chronic kidney disease. Echocardiograms revealed that 93.5% of patients had at least one abnormality, with increased left ventricle (LV) wall thickness in 59.8% and abnormal LV relaxation in 28.7%.

Conclusion: Symptoms such as dyspnea, exercise intolerance, exertional chest pain, and easy fatigability should prompt early referral to cardiology, particularly in middle-aged and older patients with the relevant comorbidities seen in this study. Incorporating these clinical indicators into electronic medical records can enhance early recognition and diagnosis of HFpEF, improving patient outcomes.