Observational longitudinal cohort study to determine progression to heart failure in a screened community population: the Echocardiographic Heart of England Screening Extension (ECHOES-X) study

Taylor, Clare; Roalfe, Andrea; Tait, Lynda; Davis, Russell; Iles, Rachel; Derit, Marites; Hobbs, FD Richard

doi:10.1136/bmjopen-2014-005256

Cited by 5 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…24 When applied in the primary care setting, 125 pg/mL for NTproBNP results in a negative predictive value of over 99 % at the cost of many more echocardiograms than a cut-off value of 400 pg/mL, which has a negative predictive value of about 97 %. 18 Missed cases will mainly be those with HFpEF. 18 Using low cut-off points for non-acute patients suspected of HF is useful in the light of the lower a priori chance of disease and, most importantly, because of the milder severity of the disease than in acute breathlessness.…”

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

“…18 Missed cases will mainly be those with HFpEF. 18 Using low cut-off points for non-acute patients suspected of HF is useful in the light of the lower a priori chance of disease and, most importantly, because of the milder severity of the disease than in acute breathlessness. 2,18 It should be noted that in the case of non-acute breathlessness, other causes may underlie elevated NTproBNP levels, including AF, age over 75 years, renal impairment and LV hypertrophy, but not mild-to-moderate COPD.…”

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

“…18 Using low cut-off points for non-acute patients suspected of HF is useful in the light of the lower a priori chance of disease and, most importantly, because of the milder severity of the disease than in acute breathlessness. 2,18 It should be noted that in the case of non-acute breathlessness, other causes may underlie elevated NTproBNP levels, including AF, age over 75 years, renal impairment and LV hypertrophy, but not mild-to-moderate COPD. 2,7 B-type natriuretic peptides (BNP and NTproBNP) are produced by myocytes in response to increased wall stress, which is in general lower in HFpEF than in HFrEF, in line with Laplace's law (wall tension=pressure x radius/wall thickness).…”

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

“…Of additional tests, natriuretic peptides are most informative and valuable. [18][19][20]23 High-risk patients (e.g. type 2 diabetes, COPD) may benefit from risk stratification based on B-type NPs and case finding.…”

Section: Moreover B-type Nps May Normalise In 24 Hours and Thus Bnp Andmentioning

confidence: 99%

See 3 more Smart Citations

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

Rutten

Gallagher

2016

Cardiac Failure Review

View full text Add to dashboard Cite

Access at: www.CFRjournal.com "I cannot keep pace with my husband. Is it simply ageing, overweight and my sedentary lifestyle?" This is a common encounter in primary care, bearing in mind that around 16 % of older community-dwelling people experience at least grade 3 shortness of breath according to the Medical Research Council questionnaire ("walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace on the level"). 1Heart failure (HF) is a common syndrome, predominantly occurring in the elderly, with a significant impact on quality of life, high mortality rates and unplanned hospitalisations that place a significant burden on health care systems and budgets in developed countries.2 General practitioners (GPs) play an important role in the disease trajectory of a patient with HF. In particular, GPs have a pivotal role in the diagnostic and palliative phase, and participate in co-operative care with specialist teams in the intervening period.Three important reasons underlie the gradual shift from hospitalbased care to primary care being seen in many developed countries.First, in the last decade, heart failure with a preserved ejection fraction (HFpEF) is increasing, while the prevalence of heart failure with a reduced ejection fraction (HFrEF) is decreasing. For HFpEF, hospital care is in general not necessary, except in cases with acute exacerbations, and it is characterised by multiple comorbidities, which benefit from generalist care. A second reason is that governments are increasingly shifting chronic disease care to primary care, given international evidence on cost-effectiveness.Studies have shown that if HFrEF patients are adequately up-titrated, the care provided by GPs is as good as that of a HF clinic.3,4 A final reason is that risk stratification with natriuretic peptides and up-titration of cardiovascular (CV) drugs of high-risk people from the community, e.g. those with a previous coronary event, hypertension or type 2 diabetes, effectively reduces the development of HF and CV hospitalisations. Early initiation or up-titration of angiotensinconverting enzyme inhibitors (ACE-inhibitors), angiotensin receptor blockers (ARBs) and beta-blockers has been shown to be effective in this group. 5,6 GPs should be prepared for this transition in care. Here, the authors give a framework for the potential role of GP in HF care throughout the natural history of the condition (see Figure 1). Definition, Diagnosis, Case Finding and Risk StratificationA diagnosis of HF requires a combination of clinical features -such as breathlessness, fatigue and ankle oedema -together with a structural or functional abnormality of the heart that impairs its ability to pump or relax on echocardiography.2,7 Pump failure may be caused by reduced contraction of the left ventricle, measured as a reduced ejection fraction (EF; <40 %). Reduced EF is almost always accompanied by impaired filling of the left ventricle, but in some patients reduced filling dominates whereas the...

show abstract

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

Section: Respiratory Symptoms and Abnormal Spirometrymentioning

confidence: 99%

Section: Moreover B-type Nps May Normalise In 24 Hours and Thus Bnp Andmentioning

confidence: 99%

See 2 more Smart Citations

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

Rutten

Gallagher

2016

Cardiac Failure Review

View full text Add to dashboard Cite

show abstract

“…We aimed to examine the long term changes in QoL of participants recruited to a large UK community screening study for HF and its rescreening study over a decade later. 9 , 10 These linked studies enable evaluation of changes in HRQoL of individuals with long‐term HF and newly diagnosed HF and those where HF was not identified by screening.…”

Section: Introductionmentioning

confidence: 99%

Long term changes in health‐related quality of life for people with heart failure: the ECHOES study

2022

View full text Add to dashboard Cite

Aims Heart failure (HF) impairs all aspects of health‐related quality of life (HRQoL), but little is known about the effect of developing HF on HRQoL over time. We aimed to report changes in HRQoL over a 13‐year period. Methods and results HRQoL was measured in the Echocardiographic Heart of England Screening (ECHOES) study and the ECHOES‐X follow‐up study ( N = 1618) using the SF‐36 questionnaire (Version 1). Mixed modelling compared changes in HRQoL across diagnostic groups, adjusting for potential predictors and design variables. Patients who had developed HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) at rescreening had significantly greater reduction in physical functioning (PF) and role physical (RP) scores compared with those without HF; adjusted mean difference in PF: HFrEF −16.1, [95% confidence interval (CI) −22.2 to −10.1]; HFpEF −14.6, (95% CI −21.2 to −8.1); in RP: HFrEF −20.7, (95% CI −31.8 to −9.7); HFpEF −19.3, (95% CI −31.0 to −7.6). Changes in HRQoL of those with a HF diagnosis at baseline and rescreen, with exception of role emotion, were similar to those without HF but started from a much lower baseline score. Conclusions People with a new diagnosis of HF at rescreening had a significant reduction in HRQoL. Conversely, for those with HF detected on initial screening, little change was observed in HRQoL scores on rescreening. Further research is required to understand the development of HF over time and to test interventions designed to prevent decline in HRQoL, potentially through earlier diagnosis and treatment optimization.

show abstract

How big a problem is heart failure with a normal ejection fraction?

Rutten

Clark

Hoes

2016

BMJ

View full text Add to dashboard Cite

Observational longitudinal cohort study to determine progression to heart failure in a screened community population: the Echocardiographic Heart of England Screening Extension (ECHOES-X) study

Cited by 5 publications

References 21 publications

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

What the General Practitioner Needs to Know About Their Chronic Heart Failure Patientt

Long term changes in health‐related quality of life for people with heart failure: the ECHOES study

How big a problem is heart failure with a normal ejection fraction?

Contact Info

Product

Resources

About