Cantu-Martinez Omar, Girard Andrew A, Jin Weiwei, Rinderknecht Derek, Cheek Thomas, Spertus John A
University of Missouri - Kansas City's Healthcare Institute for Innovations in Quality, Kansas City, MO.
Saint Luke's Mid America Heart Institute, Kansas City, MO.
medRxiv. 2025 Feb 27:2025.02.25.25322868. doi: 10.1101/2025.02.25.25322868.
Heart failure (HF) is frequently underrecognized in primary care due to nonspecific symptoms and limited screening, resulting in many patients presenting with severely compromised health status (symptoms, functional ability, and quality of life) at the time of diagnosis.
To evaluate the diagnostic yield of screening outpatients at risk for HF using a noninvasive assessment of left ventricular end-diastolic pressure (LVEDP) and to describe the health status of patients newly identified with elevated LVEDP.
A convenience sample of adults with diabetes mellitus (DM), chronic kidney disease (CKD), or suspected HF were screened at three primary care clinics using the Vivio System to identify patients with LVEDP >18 mmHg (positive screening). Among patients with a positive screening result, their health status was evaluated using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score.
Among 2040 screened patients (mean age 74±8 years; 49.8% women; 64.6% with DM; and 34.9% with CKD) 38.5% had an elevated LVEDP. Older patients, women, and those with CKD were more likely to have an elevated LVEDP (p<0.01 for all). Of 653 KCCQ-OS scores collected (mean 85±20), 31.4% had a KCCQ-OS of 100 (asymptomatic), and 26.5% had a KCCQ-OS <80, consistent with NYHA class II-IV.
Nearly 40% of patients had a positive screening, and over two-thirds reported significant health status impairments. Combining the KCCQ with noninvasive LVEDP assessment can identify patients who may require further HF evaluation. Future studies can assess the impact of these strategies on patients' subsequent health status and clinical events.
由于症状不具特异性且筛查手段有限，心力衰竭（HF）在初级保健中常常未得到充分认识，导致许多患者在确诊时健康状况（症状、功能能力和生活质量）已严重受损。
通过对左心室舒张末期压力（LVEDP）进行无创评估，评估筛查有HF风险的门诊患者的诊断收益，并描述新发现LVEDP升高的患者的健康状况。
在三家初级保健诊所，使用Vivio系统对患有糖尿病（DM）、慢性肾脏病（CKD）或疑似HF的成年患者进行便利抽样筛查，以识别LVEDP>18 mmHg的患者（筛查阳性）。在筛查结果为阳性的患者中，使用堪萨斯城心肌病问卷总体总结（KCCQ-OS）评分评估其健康状况。
在2040名接受筛查的患者中（平均年龄74±8岁；49.8%为女性；64.6%患有DM；34.9%患有CKD），38.5%的患者LVEDP升高。老年患者、女性和患有CKD的患者更有可能LVEDP升高（所有p<0.01）。在收集的653份KCCQ-OS评分中（平均85±20），31.4%的患者KCCQ-OS为100（无症状），26.5%的患者KCCQ-OS<80，符合纽约心脏协会II-IV级。
近40%的患者筛查结果为阳性，超过三分之二的患者报告有明显的健康状况损害。将KCCQ与无创LVEDP评估相结合，可以识别可能需要进一步进行HF评估的患者。未来的研究可以评估这些策略对患者后续健康状况和临床事件的影响。
