Utility of Mobile phone app-assisted screening for heart failure in primary care: Insights from the ECHOS3 registry

BACKGROUND: The prognosis of heart failure is comparable to that of some of the most prevalent cancers, highlighting the importance of early diagnosis. This study aimed to assess whether a mobile phone application could assist in the screening and early identification of HF in primary care settings. METHODS: The Echocardiographic Society of Serbia launched a multicenter screening program in which general practitioners used a custom-designed mobile application to assess patients without a prior HF diagnosis. The app recommended referral for echocardiography and natriuretic peptide testing in patients presenting with a combination of cardiovascular risk factors or symptoms suggestive of HF. HF diagnosis encompassed all left ventricular ejection fraction (EF) phenotypes following the 2021 European Society of Cardiology guidelines. RESULTS: Among 1028 screened outpatients (mean age 66 ± 11 years, 55 % female), 351 (34.1 %) were diagnosed with HF. The majority of cases were classified as having HF with preserved ejection fraction (HFpEF) (70.1 %), followed by HF with mildly reduced EF (14.2 %) and HF with reduced EF (15.7 %). Multivariate regression analysis identified advanced age, atrial fibrillation, established coronary artery disease, abnormal electrocardiogram, chronic kidney disease, and a long-standing hypertension as independent predictors of newly diagnosed HF. Furthermore, by refining the cutoffs of traditional HF risk factors, we introduce the new ECHOS3 score for HF screening in primary care which demonstrates high sensitivity (88 %), but suboptimal specificity (35 %). CONCLUSIONS: Mobile app-assisted screening in primary care, based on risk factors and symptoms, effectively identified de novo HF in approximately one-third of patients, with HFpEF accounting for the majority of cases. This innovative approach may serve as an effective strategy for the early detection of HF, particularly in outpatients with borderline natriuretic peptide levels.