A structured, ultrasound supported approach to heart failure assessment and referral prioritisation in primary care: a real-world experience
J Roca PujolAbstract
Background
Suspected heart failure (HF) is a common reason for consultation in Primary Care (PC). Many referrals could result in heterogeneous prioritisation. In a context of increasing healthcare pressure, strategies that allow early identification of heart failure at first contact may improve referral prioritisation while maintaining patient safety.
Aim
To describe a real-world, structured approach to HF assessment in Primary Care integrating clinical, NT-proBNP and multiorgan point-of-care ultrasound, and to analyse its association with subsequent HF-related hospital admissions.
Methods
Between 2021 and 2025, all consecutive patients consulting in a Primary Care practice for suspected HF. All patients underwent clinical evaluation and NT-proBNP testing. Point-of-care ultrasound (focused cardiac ultrasound, lung ultrasound and VExUS) was performed in 80 patients (four home-care patients with HF lacked imaging data. HF was considered confirmed based on compatible symptoms together with elevated NT-proBNP and/or relevant structural findings on ultrasound. Clinically significant structural heart disease was defined as left ventricular systolic dysfunction, moderate valvular disease, relevant pericardial effusion, aortic root dilatation, or marked left ventricular hypertrophy (≥14 mm).
Results
A total of 84 patients were evaluated. HF was confirmed in 30 patients (35.7%). During follow-up, 20 patients (23.8%) required hospital admission, including 8 admissions for HF decompensation (9.5%) and 12 for non-HF causes (14.3%). Four patients died (4.8%), including two HF-related deaths. Among the 80 patients with imaging, clinically significant structural heart disease was identified in 26 (32.5%). Relevant findings included: pericardial effusions, cardiac tamponade, valvular chordae rupture, two confirmed cases of cardiac amyloidosis. All HF-related admissions occurred in patients with significant structural heart disease (8/20), while no HF admissions were observed among patients without relevant structural findings (0/54). Patients with non-significant findings, such as lipedema, non-significant valvular disease or mild left ventricular hypertrophy (<14 mm) were safely managed in Primary Care without HF related hospitalisation.
Conclusions
In a real-world Primary Care cohort assessed for suspected HF, an integrated approach combining clinical evaluation, NT-proBNP and point-of-care ultrasound identified heart failure and supported referral prioritisation. HF-related admissions clustered exclusively in patients with significant structural findings, while patients with non-significant abnormalities did not experience HF hospitalisation. This ultrasound-supported strategy may improve the efficiency and safety of referral pathways from Primary Care.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.