The hidden face of heart failure risk among women in Ireland - an interim analysis of the Her-Heartbeat Project
S Oneill, J Lahkar, Z Zahid, B Dalton, M Ryder, M Ledwidge, J Gallagher, F Perez-Rastelli, J Maher, K McdonaldAbstract
Introduction
There is an established gender disparity affecting women in heart failure impacting prevention, diagnosis, specialist referral and treatment (1). The recently established "Her Heartbeat Project" focuses on the prevention, diagnosis and management of heart failure in women. This project draws from the already established Chronic Disease Management Programme (CDM) in Ireland where patients at risk of heart failure are eligible for routine natriuretic peptide (NP) assessment. We herein report on the initial experience of this service focusing on this vulnerable and underserved patient group.
Methods
For this project we are selecting 500 women from the CDM program within our catchment area who have established risk factors for heart failure such as hypertension (HTN), diabetes mellitus (DM), vascular disease, valvular disease and exposure to toxins, e.g. chemotherapy. Women with a NTproBNP of >125 pg/ml or BNP levels >50 pg/ml are referred for Doppler-echocardiographic study to assess for signs of pre-clinical heart strain, defined by one or more of the following features: mean E/e’ > 13, left ventricular mass indexed (LVMI) to body surface area (BSA) of > 110 g/m2, at least moderate valvular disease, left atrial volume indexed (LAVI) to BSA of > 34 ml/m2 or an ejection fraction (EF) of < 50%. In addition, they are reviewed by a cardiologist and a clinical nurse specialist to establish the possible presence of undiagnosed heart failure.
Results
To date we have assessed 241 patients of the planned cohort of 500. The average age was 66.9 years with an average BMI of 28.6 kg/m2. 65% had HTN, 56% dyslipidaemia, 21% DM and 1.6% valvular disease. 4.5% had coronary artery disease and 1.6% have had a myocardial infarction. 10.8% had a previous breast cancer diagnosis with 5.3 % having undergone chemotherapy. The average NT-proBNP was 139.10 pg/ml and the average BNP 78.7 pg/ml, resulting in 27.3 % of patients having abnormal NP levels. To date 70 of this cohort have had their Doppler-echocardiographic study with 76% of patients demonstrating heart strain. The most prevalent abnormality to date is LAVI > 34 ml/m2 in 61.4 % of patients, 27.1 % had an E/e’ of > 13, 12.8 % had a LVMI of > 110 g/m2, 15.7% patients had at least moderate valvular disease, and 4.3% of patients had an EF of < 50%. Three patients had clinical symptoms and/or signs of heart failure.
Conclusion
The ongoing analysis of heart failure risk among women demonstrates a high prevalence of heart strain with evidence of significant pre-clinical diastolic impairment. In addition, this service is diagnosing a small number of previously undiagnosed HF. These observations will allow for focused prevention strategies to be put in place and enable earlier diagnosis of heart failure through the prompt of an elevated NP level. The national and international feasibility of this service requires further study.