Diagnostic Approaches to Heart Failure in Primary Care

Heart failure is a common and progressively disabling condition often first encountered in the community setting. In primary care, patients typically present with non-specific symptoms such as breathlessness, fatigue and fluid retention, which overlap with multiple other pathologies. Early and accurate identification of heart failure facilitates timely initiation of evidence-based therapies and can reduce hospital admissions and mortality. Current diagnostic pathways combine clinical assessment, biomarker assays and imaging. Clinical decision rules integrate patient history, examination findings and risk factors to guide further investigation. Measurement of natriuretic peptides, notably N-terminal pro-B-type natriuretic peptide (NT-proBNP), serves as a rapid rule-out test when levels are below guideline-recommended thresholds and as a rule-in test at higher thresholds. Patients with raised biomarkers are referred for echocardiography, which remains the gold standard for confirming structural or functional cardiac abnormalities and classifying heart failure according to ejection fraction. In resource-constrained settings, point-of-care testing for natriuretic peptides and novel non-invasive functional assessments have emerged to bridge diagnostic gaps. Advances in portable bioreactance technology now permit measurement of cardiac output response to stress in the clinic, potentially reducing unnecessary secondary-care referrals. Harmonisation of European and national guideline thresholds, alongside the development of clinical pathways that combine biomarkers, decision algorithms and novel tests, underpins efforts to optimise diagnostic accuracy, streamline referral patterns and improve patient outcomes globally.

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Diagnostic Approaches to Heart Failure in Primary Care publication trend

The graph below shows the total number of articles in diagnostic approaches to heart failure in primary care across all publications each year (not limited to Nature Index journals).

Technical terms

Natriuretic peptides: Hormones released by cardiac myocytes in response to increased wall stress, used as biomarkers for heart failure.

NT-proBNP: N-terminal pro-B-type natriuretic peptide, a fragment measured in blood to assess cardiac stress and guide heart failure diagnosis.

Echocardiography: Ultrasound imaging technique to visualise cardiac structure and function, including chamber sizes and ejection fraction.

Ejection fraction: Percentage of blood ejected from the left ventricle with each contraction, used to classify heart failure subtypes.

CORS test: Cardiac Output Response to Stress test, a non-invasive protocol measuring changes in cardiac output under controlled exercise or positional stress using bioreactance.

References

1. Diagnostic accuracy of point-of-care natriuretic peptide testing for chronic heart failure in ambulatory care: systematic review and meta-analysis. The BMJ (2018).
2. Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study. BMJ Open (2019).
3. Diagnosing heart failure in primary care: individual patient data meta‐analysis of two European prospective studies. ESC Heart Failure (2021).
4. A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care. ESC Heart Failure (2018).
5. Feasibility of the cardiac output response to stress test in suspected heart failure patients. Family Practice (2022).