Early Detection and IntervenTion in Heart Failure

Heart Failure (HF)

NT-proBNP, Stepped-Wedge, Undetected Heart Failure, Heart Failure, Implementation Science

Heart failure (HF) occurs when the heart is no longer able to pump blood effectively throughout the body. This leads to symptoms that gradually worsen over time and are often mistaken for normal signs of aging. Because of its insidious onset, early detection is challenging. Both patients and healthcare professionals are often insufficiently aware of the early signs and symptoms of HF, resulting in delayed diagnosis. Consequently, timely initiation of treatments that could slow disease progression, improve quality of life, and reduce hospitalizations is often missed. Although a simple blood test measuring NT-proBNP levels can facilitate the early diagnosis of HF, it is not routinely used in clinical practice. The aim of this study is to evaluate whether a combined strategy for the early diagnosis and treatment of HF can reduce hospitalizations. This strategy includes: 1. increasing awareness of HF among patients and physicians, 2. using NT-proBNP testing for the early detection of HF in high-risk patients, and 3. promptly initiating guideline-directed HF treatment when the diagnosis is confirmed. The researchers will assess whether this strategy effectively reduces hospitalizations due to acute heart failure over an 18-month follow-up period.

Heart failure (HF) is a significant global health issue, affecting approximately 64 million individuals worldwide and resulting in over a million hospitalizations annually in Europe and the US. This imposes substantial healthcare costs exceeding $100 billion yearly, with about 70% attributed to acute hospitalizations. The aging population contributes to a rising burden, as HF is often diagnosed late, even in well-funded healthcare settings. Recent insights from studies, including the ongoing BASEL VIII study, challenge the assumption that undetected HF is primarily a failure to detect HF in primary care, revealing a high prevalence of undetected HF even among patients treated by cardiologists. This research initiative revealed that among patients ≥ 65 years, only 3% had known HF, while 29% had undetected HF. Similar observations were also noted in various high-risk settings worldwide, suggesting a surprisingly high rate of undetected HF in clinical practice. Late diagnosis is driven by gradual symptom development, non-specific symptoms often attributed to aging, insensitive clinical signs, and inadequate utilization of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, the recommended tools for HF diagnosis. The misconception that HF competes with other cardiac diagnoses, rather than complementing them, further contributes to delayed diagnosis. Emerging evidence supports a strategy combining increased awareness, active surveillance using NT-proBNP testing for early HF diagnosis, and prompt treatment with approved evidence-based therapies to reduce HF hospitalizations. However, such intervention bundles are not systematically applied, as no randomized controlled trial (RCT) has ever investigated the efficacy of such structured interventions on hard outcomes. This research initiative aims to assess the effectiveness of an intervention bundle comprising increased awareness, early diagnostics, and early treatment to improve HF prognosis. The study aims to fill critical gaps and evaluate patient-centred outcomes, including hospitalization for acute HF, and health economic implications by using routine clinical data and the standard operating procedures as part of routine clinical practice in the participating sites. By addressing these challenges, the initiative seeks to enhance patient outcomes, reduce the burden on healthcare systems, and contribute to advancing HF care. The bundle intervention, comprising an educational program, guidelines-directed diagnostics, and guidelines-supported management, represents a proactive implementation of best clinical practice. As this proactive approach is not routinely implemented in real-world clinical dynamics, this study primarily focuses on accompanying the implementation of the intervention bundle and contributing valuable data regarding its efficacy. At the same time, the intervention is expected to offer a number of potential benefits for the patients, their health care providers, and the society in general. This will be achieved by a better understanding of the HF problem among patients and medical staff, better adherence to guidelines-supported best clinical practices, and the potential avoidance of hospitalisations due to acute HF.

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