PMID- 32187879
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 7
IP  - 3
DP  - 2020 Jun
TI  - Real-world clinical diagnostics of heart failure patients with reduced or 
      preserved ejection fraction.
PG  - 1039-1048
LID - 10.1002/ehf2.12665 [doi]
AB  - AIMS: The study aimed at investigating the use of guideline-recommended 
      diagnostic tools and medication in patients with heart failure (HF) in specialty 
      care in Southwest Finland. We also compared the characteristics of the diagnosed 
      and undiagnosed patients as well as laboratory tests, procedures, and treatments 
      in everyday clinical practice. METHODS AND RESULTS: Patients diagnosed with HF, 
      cardiomyopathy, or hypertension-induced heart disease (n = 20 878, primary 
      cohort) or not diagnosed with HF but having a record of elevated N-terminal 
      pro-brain natriuretic peptide (NT-proBNP) (>125 ng/L, n = 24 321, secondary 
      cohort) were included in the study from the specialty care patient register of 
      the Hospital District of Southwest Finland during the years 2005-2017. Among 
      patients with an International Classification of Diseases, Tenth Revision 
      (ICD-10) code for HF, only 50% had ejection fraction (EF) data to be found by 
      data mining from the electronic health records. Of these patients, 39% (n = 4042) 
      had EF </= 40% [HF with reduced EF (HFrEF)] and 61% (n = 6347) had EF > 40%. 
      Elevated NT-proBNP together with EF > 40% narrowed down the number to 4590 
      patients, a population defined as HF with preserved EF (HFpEF) patients. HFpEF 
      patients were further stratified into HF with mildly reduced EF (HFmrEF; EF 
      41-50%, n = 1468) and EF > 50% patients (n = 3122) to compare clinical 
      characteristics. NT-proBNP was higher within the HFrEF patients vs. HFpEF 4580 
      [inter-quartile range (IQR): 2065-9765] vs. 2900 [2065-9765] ng/L, P < 0.001. 
      Baseline co-morbidities differed between HFpEF and HFrEF groups. Further, HFpEF 
      patients had more procedures and lab tests taken prior to diagnosis than had 
      HFrEF patients. HFmrEF patients were found to resemble more HFrEF than EF > 50% 
      patients. In 70% (n = 17 156) of patients in the secondary cohort, the NT-proBNP 
      concentrations were >300 ng/L, median was 1090 (IQR 551-2558) ng/L and EF 
      58.4 +/- 12.1% (n with EF available = 6845). Reduced EF was present in 6.8% of 
      patients lacking HF diagnosis. CONCLUSIONS: Half of the patients with ICD-10 code 
      for HF did not have EF data available after a visit at specialty care. In 
      particular, the diagnosis of HFpEF seems challenging, reflected as an increase in 
      procedures and laboratory test preceding diagnosis compared with those in HFrEF 
      patients. Also, a large proportion of patients did not have HF diagnosis, yet 
      they presented elevated NT-proBNP concentrations and clinical characteristics 
      resembling those of HFpEF patients.
CI  - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of the European Society of Cardiology.
FAU - Huusko, Jenni
AU  - Huusko J
AD  - Novartis Finland Oy, Espoo, Finland.
FAU - Purmonen, Timo
AU  - Purmonen T
AD  - Novartis Finland Oy, Espoo, Finland.
FAU - Toppila, Iiro
AU  - Toppila I
AD  - Medaffcon Oy, Espoo, Finland.
FAU - Lassenius, Mariann
AU  - Lassenius M
AD  - Medaffcon Oy, Espoo, Finland.
FAU - Ukkonen, Heikki
AU  - Ukkonen H
AD  - Heart Center, Turku University Hospital, Turku, Finland.
LA  - eng
GR  - 00/Novartis Pharmaceuticals/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200318
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
SB  - IM
MH  - Cohort Studies
MH  - Finland/epidemiology
MH  - *Heart Failure/diagnosis/epidemiology
MH  - Humans
MH  - Stroke Volume
PMC - PMC7261561
OTO - NOTNLM
OT  - Diagnosis
OT  - HFpEF
OT  - HFrEF
OT  - Heart failure
OT  - Real-world evidence
COIS- J. Huusko and T. Purmonen are employees of Novartis Finland Oy. M. Lassenius and 
      I. Toppila are employees of Medaffcon Oy. H. Ukkonen declares that he has no 
      conflicts of interest.
EDAT- 2020/03/19 06:00
MHDA- 2021/06/22 06:00
PMCR- 2020/03/18
CRDT- 2020/03/19 06:00
PHST- 2019/09/17 00:00 [received]
PHST- 2020/01/24 00:00 [revised]
PHST- 2020/02/14 00:00 [accepted]
PHST- 2020/03/19 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/03/19 06:00 [entrez]
PHST- 2020/03/18 00:00 [pmc-release]
AID - EHF212665 [pii]
AID - 10.1002/ehf2.12665 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2020 Jun;7(3):1039-1048. doi: 10.1002/ehf2.12665. Epub 2020 Mar 
      18.