From referral to therapy: opportunities for treatment optimisation in heart failure with preserved ejection fraction across care settings
A Munawwar, B Din, A Sengupta, A Walker, A Simms, C Saunderson, K Witte, S Straw, K GatenbyAbstract
Background
Heart failure with preserved ejection fraction accounts for approximately half of all heart failure cases and is frequently accompanied by multiple comorbidities, making diagnosis and management challenging. Although evidence-based therapies are available, their uptake in routine clinical practice remains inconsistent.
Purpose
This service evaluation aimed to assess diagnostic patterns and pharmacological management of patients diagnosed with heart failure with preserved ejection fraction, in conjunction with primary and secondary care, to address gaps, improve therapy utilisation, and support a coordinated management pathway across care settings.
Methods
Electronic health records were used to identify adults diagnosed with heart failure with preserved ejection fraction via the intermediate N-terminal pro–B-type natriuretic peptide diagnostic pathway between February 2023 and February 2024. A retrospective analysis was conducted evaluating demographics, comorbidities, diagnostic investigations, and pharmacological therapy before and after diagnosis.
Results
A total of 178 patients were included. Mean age was 80.2 ± 7.4 years, 62.4% were female, and mean body mass index was 30.2 ± 7.3 kg/m². Most patients had at least one comorbidity, most commonly hypertension (74.7%) and atrial fibrillation (59.0%). Median time from referral to diagnosis was 50 days. Following diagnosis, use of sodium–glucose cotransporter-2 inhibitors increased from 4.5% to 61.6% (p<0.001), mineralocorticoid receptor antagonists from 3.4% to 13.4% (p<0.001), loop diuretics from 25.3% to 47.6% (p<0.001), and glucagon-like peptide-1 receptor agonists from 0% to 0.6%.
Conclusion
Pharmacological management of heart failure with preserved ejection fraction improved following diagnosis; however, opportunities remain to optimise the use of evidence-based therapies. These findings support coordinated collaboration across primary and secondary care and the development of an integrated, multidisciplinary care pathway proposed in this study to enhance treatment implementation across care settings.Demographic and clinical characteristicsFor image description, please refer to the figure legend and surrounding text.pre vs post diagnosis prescription ratesFor image description, please refer to the figure legend and surrounding text.