Abstract 11676: Use of Natriuretic Peptides and Echocardiography for Diagnosing Heart Failure

Introduction: International guidelines have recommended the use of echocardiography and natriuretic peptides (NP) in the diagnostic evaluation of heart failure (HF) for more than 10 years. However, real-world utilization of these tests in the US is not known.

Objective: To assess contemporary trends in echocardiography and NP testing for diagnosing HF in the US.

Methods: The TriNetX data was queried to ascertain the total number of first HF diagnoses in adults aged

18 in the US from 2016-2019. A random cohort was selected with the following exclusions applied: history of infiltrative or congenital causes of HF, need for heart transplant/ventricular assist device, no healthcare utilization 1 year before diagnosis, fewer than 2 recorded HF diagnoses, and without a valid visit type recorded. NP testing and echocardiography any time before through one year following index diagnosis were assessed. Temporal trend significance was evaluated using Cochran-Armitage trend tests.

Findings: A total of 124,126 patients were included in the study. Mean age was 68

13 years, 53% were male, and 71% were White. Overall, 61,023 (49%) diagnoses were made in the outpatient and 63,103 (51%) in the inpatient setting with a significantly increasing trend toward inpatient diagnoses (p<0.001; Figure 1A ). Of all incident HF diagnoses, 67,991 (55%) patients underwent NP testing, 70,612 (57%) patients underwent echocardiography, and 31,206 (25%) patients did not undergo either diagnostic test. There were increasing trends in the proportion of patients diagnosed in inpatient vs outpatient among those who underwent NP testing, echocardiography, and either diagnostic test (p<0.001; Figure 1B-D ).

Conclusions: We found low rates of echocardiography and NP testing in those with HF, with more such testing performed in patients diagnosed inpatient. We also found increasing rates of inpatient HF diagnoses, indicating lost opportunities for earlier treatment initiation and worse outcomes.