Diagnostic work-up for heart failure in hospital and outpatient cardiology care: a web-based cross-sectional survey
M Tokmakova, Y Yotov, E Trendafilova, N Runev, S Tisheva, P Gatzov, A Vladimirova, R RaychevaAbstract
Background
Diagnostic profiling is essential for heart failure (HF) care, particularly in patients with cardio-renal-metabolic comorbidity. How routinely key investigations are used across care settings is not well described.
Purpose
To compare diagnostic work-up patterns between hospitalized and outpatient HF care.
Methods
A steering committee developed a web-based cross-sectional survey completed by cardiologists working in hospital and outpatient settings. Consecutive patients with HF were prospectively reported during a fixed period (1 June–10 July 2025). The survey captured functional status, laboratory testing (including renal and metabolic profiling), and echocardiographic parameters. Continuous variables were reported as median (IQR) and categorical variables as n (%). Hospitalized vs outpatient groups were compared using Mann–Whitney U for continuous variables and chi-square/Fisher’s exact tests for categorical variables; differences in proportions were assessed with a z-test. Missing data were reported without imputation; two-sided p<0.05 was considered significant.
Results
Overall, 1,438 patients were included (outpatients n=971; hospitalized n=467). Natriuretic peptide testing was uncommon: among patients in sinus rhythm (n=995), N-terminal pro-B-type natriuretic peptide was not measured in 74.3% (76.7% outpatient vs 69.5% hospitalized; p=0.014). Renal assessment differed by setting: estimated glomerular filtration rate was missing in 8.8% overall (11.2% outpatient vs 3.6% hospitalized; p<0.001), while urine albumin–creatinine ratio was checked more often outpatient (7.9% vs 3.2%; p=0.001). Hemoglobin A1c was assessed more frequently outpatient (45.4% vs 38.3%; p=0.011), whereas lipid testing was more frequent in hospitalized patients (94.6% vs 88.0%; p<0.001). Potassium was not measured in 11.8% overall (14.5% outpatient vs 5.8% hospitalized; p<0.001).
Conclusion
Marked setting-related differences were observed in diagnostic work-up of HF patients, alongside substantial underuse of natriuretic peptides and gaps in renal/metabolic profiling. These findings support focused quality improvement, particularly for outpatient pathways and standardized profiling.For image description, please refer to the figure legend and surrounding text.