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Abstract：
OBJECTIVE: This study aimed to examine the diagnostic pathways and outcomes of patients with heart failure (HF), stratified by left ventricular ejection fraction (EF), and to highlight deficiencies in real-world HF diagnosis and management.
RESULTS: We conducted a retrospective cohort study in Salford, United Kingdom, utilizing linked primary and secondary care data for HF patients diagnosed between January 2010 and November 2019. We evaluated characteristics, diagnostic patterns, healthcare resource utilization, and outcomes. Patients were categorized according to baseline (the latest measure prior to or within 90 days post-diagnosis) as having HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), or preserved EF (HFpEF). The data encompassed a 2 year period before diagnosis and up to 5 years post-diagnosis. A total of 3227 patients were diagnosed with HF between January 2010 and November 2019. The mean follow-up time was 2.6 [±1.9 standard deviation (SD)] years. The mean age at diagnosis was 74.8 (±12.7 SD) years, and 1469 (45.5%) were female. HFpEF was the largest cohort (46.6%, npEF = 1505), HFmrEF constituted 16.1% (nmrEF = 520), and HFrEF 18.5% (nrEF = 596) of the population, while 18.8% (nu = 606) of patients remained unassigned due to insufficient evidence to support categorization. At baseline, measurement of natriuretic peptide (NP; brain NP and N-terminal pro-B-type NP) and echocardiographic report data were available for 592 (18.3%) and 2621 (81.2%) patients, respectively. A total of 2099 (65.0%) of the HF cohort had access to a cardiology-led outpatient clinic prior to the HF diagnosis, and 602 (18.7%) attended cardiac rehabilitation post-diagnosis. The 5 year crude survival rate was 37.8% [95% confidence interval (CI) (35.2-40.7%)], 42.3% [95% CI (38.0-47.2%)], and 45.5% [95% CI (41.0-50.4%)] for HFpEF, HFrEF, and HFmrEF, respectively.
CONCLUSIONS: Low survival rates were observed across all HF groups, along with suboptimal rates of NP testing and specialist assessments. These findings suggest missed opportunities for timely and accurate HF diagnosis, a pivotal first step in improving outcomes for HF patients. Addressing these gaps in diagnosis and management is urgently needed.
RESULTS: We conducted a retrospective cohort study in Salford, United Kingdom, utilizing linked primary and secondary care data for HF patients diagnosed between January 2010 and November 2019. We evaluated characteristics, diagnostic patterns, healthcare resource utilization, and outcomes. Patients were categorized according to baseline (the latest measure prior to or within 90 days post-diagnosis) as having HF with reduced EF (HFrEF), mildly reduced EF (HFmrEF), or preserved EF (HFpEF). The data encompassed a 2 year period before diagnosis and up to 5 years post-diagnosis. A total of 3227 patients were diagnosed with HF between January 2010 and November 2019. The mean follow-up time was 2.6 [±1.9 standard deviation (SD)] years. The mean age at diagnosis was 74.8 (±12.7 SD) years, and 1469 (45.5%) were female. HFpEF was the largest cohort (46.6%, npEF = 1505), HFmrEF constituted 16.1% (nmrEF = 520), and HFrEF 18.5% (nrEF = 596) of the population, while 18.8% (nu = 606) of patients remained unassigned due to insufficient evidence to support categorization. At baseline, measurement of natriuretic peptide (NP; brain NP and N-terminal pro-B-type NP) and echocardiographic report data were available for 592 (18.3%) and 2621 (81.2%) patients, respectively. A total of 2099 (65.0%) of the HF cohort had access to a cardiology-led outpatient clinic prior to the HF diagnosis, and 602 (18.7%) attended cardiac rehabilitation post-diagnosis. The 5 year crude survival rate was 37.8% [95% confidence interval (CI) (35.2-40.7%)], 42.3% [95% CI (38.0-47.2%)], and 45.5% [95% CI (41.0-50.4%)] for HFpEF, HFrEF, and HFmrEF, respectively.
CONCLUSIONS: Low survival rates were observed across all HF groups, along with suboptimal rates of NP testing and specialist assessments. These findings suggest missed opportunities for timely and accurate HF diagnosis, a pivotal first step in improving outcomes for HF patients. Addressing these gaps in diagnosis and management is urgently needed.
摘要：
目的：本研究旨在研究心力衰竭（HF）患者的诊断途径和结果，按左心室射血分数（EF）分层，并强调现实世界HF诊断和管理中的不足。
结果：我们在索尔福德进行了一项回顾性队列研究，英国,利用2010年1月至2019年11月期间诊断的HF患者的相关初级和二级护理数据.我们评估了特征，诊断模式，医疗保健资源利用，和结果。根据基线（诊断前或诊断后90天内的最新测量值）将患者分类为心力衰竭并降低EF（HFrEF）。轻度降低EF（HFmrEF），或保存的EF（HFpEF）。数据包括诊断前2年和诊断后5年。在2010年1月至2019年11月期间，共有3227例患者被诊断为HF。平均随访时间为2.6[±1.9标准差(SD)]年。诊断时的平均年龄为74.8（±12.7SD）岁，1469人(45.5%)为女性。HFpEF是最大的队列(46.6%，npEF=1505)，HFmrEF占16.1%(nmrEF=520)，和HFrEF18.5%(nrEF=596)的人口，而18.8%(nu=606)的患者由于支持分类的证据不足而未分配.在基线,592例(18.3%)和2621例(81.2%)患者可获得利钠肽(NP;脑NP和N末端前B型NP)和超声心动图报告数据,分别。在HF诊断前，共有2099名（65.0%）的HF队列进入了心脏病学主导的门诊诊所。602例(18.7%)在诊断后接受了心脏康复治疗。5年粗生存率为37.8%[95%置信区间(CI)(35.2-40.7%)],42.3%[95%CI（38.0-47.2%）]，HFpEF为45.5%[95%CI（41.0-50.4%）]，HFrEF,和HFmrEF,分别。
结论：所有HF组均观察到低生存率，以及NP测试和专家评估的次优率。这些研究结果表明错失了及时准确的HF诊断的机会，改善HF患者结局的关键的第一步.迫切需要解决诊断和管理方面的这些差距。
结果：我们在索尔福德进行了一项回顾性队列研究，英国,利用2010年1月至2019年11月期间诊断的HF患者的相关初级和二级护理数据.我们评估了特征，诊断模式，医疗保健资源利用，和结果。根据基线（诊断前或诊断后90天内的最新测量值）将患者分类为心力衰竭并降低EF（HFrEF）。轻度降低EF（HFmrEF），或保存的EF（HFpEF）。数据包括诊断前2年和诊断后5年。在2010年1月至2019年11月期间，共有3227例患者被诊断为HF。平均随访时间为2.6[±1.9标准差(SD)]年。诊断时的平均年龄为74.8（±12.7SD）岁，1469人(45.5%)为女性。HFpEF是最大的队列(46.6%，npEF=1505)，HFmrEF占16.1%(nmrEF=520)，和HFrEF18.5%(nrEF=596)的人口，而18.8%(nu=606)的患者由于支持分类的证据不足而未分配.在基线,592例(18.3%)和2621例(81.2%)患者可获得利钠肽(NP;脑NP和N末端前B型NP)和超声心动图报告数据,分别。在HF诊断前，共有2099名（65.0%）的HF队列进入了心脏病学主导的门诊诊所。602例(18.7%)在诊断后接受了心脏康复治疗。5年粗生存率为37.8%[95%置信区间(CI)(35.2-40.7%)],42.3%[95%CI（38.0-47.2%）]，HFpEF为45.5%[95%CI（41.0-50.4%）]，HFrEF,和HFmrEF,分别。
结论：所有HF组均观察到低生存率，以及NP测试和专家评估的次优率。这些研究结果表明错失了及时准确的HF诊断的机会，改善HF患者结局的关键的第一步.迫切需要解决诊断和管理方面的这些差距。
