Department of Cardiovascular Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Cardiovascular Medicine, University Hospital Waterford, Waterford, Ireland.
ESC Heart Fail. 2022 Oct;9(5):3643-3648. doi: 10.1002/ehf2.14024. Epub 2022 Jun 27.
Accurate prevalence data for ambulatory advanced heart failure (HF) in European countries remains limited. This study was designed to identify the population of patients potentially eligible for referral for assessment for advanced surgical HF therapies to a National advanced HF and cardiac transplant centre.
A survey comprising 13 potential clinical markers of advanced HF was developed, modified from the 'I NEED HELP' tool from the 2018 position statement of the Heart Failure Association of the European Society of Cardiology, and distributed to all HF clinic services (secondary and tertiary units) nationwide. Each HF clinic unit was asked to complete the survey on consecutive patients over a 3 month period fulfilling the following three criteria: (i) age <65 years; (ii) ejection fraction <40% and (iii) HF of >3 months duration. As a comparison, the number of actual referrals to the advanced HF clinic were also audited over a 9 month period. In all, 21 of 26 HF clinic units participated in the survey. Across the period of inclusion, 4950 all-comer HF patients were seen across all sites. Of these, 375 (7.5%) fulfilled the inclusion criteria and were surveyed (74.4% male, median age 57 years [IQR: 11 years]). In total, 246 (66%) of the surveyed patients had ≥1 potential markers for advanced HF, representing just under 5% of the total all-comer HF population seen across the same time period. Of these, 67 patients (27%) had ≥2, 48 (20%) had 3 and 40 (16%) had ≥4 potential markers. The most frequently noted markers were ≥1 HF hospitalization or unscheduled clinic review (56%), intolerance to renin-angiotensin-aldosterone system inhibitors due to hypotension or renal dysfunction (29%) and intolerance to beta-blockers due to hypotension (27%). Almost one-quarter of patients reported NYHA Class III or IV symptoms. During the advanced HF clinic audit, the number of patients actually referred to the advanced HF clinic during the same time period was <5% of this potentially eligible cohort.
In this index prospective National survey, approximately 5% of an all-comer routine HF clinic population and two-thirds of a pre-selected HF with reduced EF under 65 years cohort were found to have at least one clinical or biochemical marker suggesting advanced or impending advanced HF. Almost one-quarter of patients in this chronic outpatient 'snapshot' population have NYHA III-IV symptoms. This simple one-page triage survey-modified from the 'I NEED HELP' tool-is useful to identify a population potentially eligible for referral to an advanced HF centre for assessment for advanced surgical therapies, thereby aiding resource and service planning.
在欧洲国家，关于门诊晚期心力衰竭（HF）的准确患病率数据仍然有限。本研究旨在确定适合转诊到国家高级 HF 和心脏移植中心评估高级外科 HF 治疗的患者人群。
开发了一项包含 13 项潜在 HF 晚期临床标志物的调查，该调查是从 2018 年欧洲心脏病学会心力衰竭协会立场声明中的“我需要帮助”工具修改而来，并分发给全国所有 HF 诊所服务（二级和三级单位）。要求每个 HF 诊所单位在 3 个月的时间内连续完成符合以下三个标准的患者调查：（i）年龄<65 岁；（ii）射血分数<40%；（iii）HF 持续时间>3 个月。作为比较，还在 9 个月的时间内审核了高级 HF 诊所的实际转诊人数。共有 26 个 HF 诊所中有 21 个参与了调查。在整个纳入期间，所有站点共观察到 4950 名 HF 患者。其中，375 名（7.5%）符合纳入标准并接受了调查（74.4%为男性，中位年龄 57 岁[IQR：11 岁]）。在总共接受调查的 375 名患者中，有 246 名（66%）患者有≥1 项潜在的高级 HF 标志物，占同期所有门诊 HF 患者的近 5%。其中，有 67 名患者（27%）有≥2 项，48 名患者（20%）有 3 项，40 名患者（16%）有≥4 项潜在标志物。最常被记录的标志物是≥1 次 HF 住院或非计划性门诊复查（56%）、因低血压或肾功能障碍而不能耐受肾素-血管紧张素-醛固酮系统抑制剂（29%）和因低血压而不能耐受β受体阻滞剂（27%）。近四分之一的患者报告有 NYHA Ⅲ或Ⅳ级症状。在高级 HF 诊所审核期间，在此期间实际转诊到高级 HF 诊所的患者人数不到该潜在合格队列的 5%。
在这项全国前瞻性索引研究中，大约 5%的所有 HF 门诊常规患者人群和约三分之二的年龄<65 岁且射血分数降低的 HF 患者中有至少一项临床或生化标志物表明存在晚期或即将出现的 HF。在这个慢性门诊“快照”人群中，近四分之一的患者有 NYHA III-IV 级症状。这项简单的一页分诊调查——改编自“我需要帮助”工具——可用于识别适合转诊到高级 HF 中心评估高级外科治疗的人群，从而有助于资源和服务规划。
