Post-COVID-19 era heart failure diagnosis and outcomes: adherence to National Institute for Health and Care Excellence Guidelines

Objective Heart failure (HF) is common with high associated morbidity and mortality. UK National Institute for Health and Clinical Excellence (NICE) Guidelines suggest prioritising assessment by natriuretic peptide (NP) level, with patients with high NP levels assessed within 2 weeks. We evaluated adherence to NICE guidelines in the post-COVID-19 era. Methods We conducted a retrospective audit of consecutive referrals to a HF diagnostic pathway across seven hospitals in the West of Scotland (between 5 January and 2 June 2022). Patients were categorised by NP level according to NICE Guidelines: NT-proBNP 400–2000 ng/L (echocardiogram within 6 weeks) or >2000 ng/L (echocardiogram within 2 weeks). Time-to-echocardiogram was recorded, and 1-year outcomes (HF hospitalisation, death) were obtained from electronic records. Results Of the 899 patients (median age 79 years, 56% female) referred for echocardiography on the HF diagnostic pathway, 264 (29%) and 635 (71%) had an NT-proBNP >2000 ng/L and 400–2000 ng/L, respectively. Only 20 (8%) patients with NT-proBNP >2000 ng/L and 51 (8%) patients with NT-proBNP 400–2000 ng/L received an echocardiogram within the recommended timeframe. 252 (28%) patients were diagnosed with HF, 110 (42%) and 142 (22%) in the NT-proBNP >2000 ng/L and 400–2000 ng/L groups, respectively, p<0.001. One-year mortality was 12% and was higher in the >2000 ng/L NT-proBNP group at 21% compared with 9% in the 400–2000 ng/L group. Conclusion High NP levels identified a high-risk group who are more likely to have HF and a higher risk of mortality. Few patients received echocardiography within the NICE Guideline-recommended timeframe. Patients with high NP levels should be investigated with the same urgency as suspected cancer.