Heart Failure 2021 Update: What physicians need to know
Heart failure is a progressive chronic syndrome characterized by decrease in functional status and quality of life, and an increased morbidity and mortality. Various developments with regards to early diagnosis and effective management have aimed to bring down the incidence of heart failure hospitalisations and mortality in heart failure patients. In India, the prevalence was estimated to be around 1.2/1000 people in the INDUS study. (1) Once developed, heart failure has a 1-year mortality rate of 7.2% and a 1-year hospitalization rate of 31.9% in patients with chronic heart failure, and in patients hospitalized for acute heart failure, these rates increase to 17.4% and 43.9%. (2) Worldwide, the burden of heart failure has increased to an estimated 23 million people.
The following article will focus on the ice-berg phenomenon in heart failure diagnosis in community and how far have we come with latest treatment options in addressing this huge burden on health care facilities across the world.
Unmet need for early and accurate diagnosis in HF
Early detection of heart failure by general practitioners (GPs) is hampered by the lack of specificity of symptoms, the presence of comorbidities, and limited access to echocardiography. Thorough physical examination in combination with echocardiography can improve the accuracy of CHF diagnostics. (3,4)
Riet et al have shown that in community-dwelling persons aged 65 years or more with shortness of breath on exertion, unrecognized heart failure is common with a prevalence of 15.7%. (5) Most patients who have undetected heart failure belong to the category of HF with preserved ejection fraction (discussed later).Their findings also suggest that GPs (and pulmonologists) seem to be less aware of heart failure in patients with COPD and that dyspnoea, abnormal pulmonary breathing sound, and fatigue could easily be misinterpreted as 'respiratory symptoms'. As long-term care residents are often unable to attend outside clinics or diagnostic facilities, the lack of availability of echocardiography in this setting further complicates diagnosis and management. (6)
Patients with heart failure present with a variety of symptoms, most of which are non- specific. Even the classical symptoms of dyspnea, edema and orthopnea havelimited sensitivities ranging from 21-66%. (7) While data on undiagnosed HF are inherently difficult to obtain, current evidence suggests that an accurate diagnosis may be missed in up to half of cases. (8)