{
  "abstract": "Introduction Epidemiological data suggest that the heart failure (HF) prevalence in the UK is ~2% of the general population. However, primary care HF registers record fewer than 1%. The ‘missing’ patients may be those prescribed a loop diuretic who are not on the HF register.Methods I audited two primary care groups (Greengates Medical Group, covering a more rural, affluent area; and Modality Partnership Hull, covering a more urban, deprived area) in East Yorkshire, UK which comprised 9 surgeries caring for 80,271 patients.From both groups’ electronic health records, patients who were prescribed a loop diuretic (furosemide or bumetanide) in the previous three months but not on the primary care HF register were identified. The search was performed on 1st March 2024 in Greengates and 1st October 2024 in Modality.Treatment indications (HF, chronic kidney disease, liver cirrhosis, hypertension, or other acute volume overload state) and HF assessment (N-terminal pro-B-type natriuretic peptide (NT-proBNP) test, echocardiography, or specialist review) performed in the preceding three months were recorded. I offered the rest of the patients NT-proBNP testing.Patients with NT-proBNP <400 ng/L were deemed not to have HF. Patients with NT-proBNP ≥400 ng/L were reviewed in a specialist HF clinic alongside echocardiography. HF diagnosis was confirmed if there was HF syndrome and either: (i) objective evidence of cardiac dysfunction on echocardiogram, or (ii) secondary care cardiologist correspondence confirming a HF diagnosis. Patients were excluded if: severely frail (Clinical Frailty Score [CFS] ≥7), aged ≥90, or terminally ill.Results From the total population (N=80,271), 662 patients were prescribed a loop diuretic in the previous three months without being on the HF register (Greengates N=278; Modality N=384). Median age was 78 (69-86) years and 61% female. One in three patients had moderate or severe frailty (CFS ≥6).Of the 662 patients, 92 were excluded and 18 did not participate (figure 1). 134 had a pre-existing HF diagnosis but were not on the register, and 65 had a non-HF indication for loop diuretic. Of the remaining 353 patients: 199 had NT-proBNP <400 ng/L; 120 had NT-proBNP ≥400 ng/L and underwent echocardiography, of whom 21 had HF; 19 underwent echocardiography without NT-proBNP, of whom 2 had HF; and 10 underwent specialist assessment of whom none had HF.Of the 157 (24%) patients with HF: 51 had left ventricular impairment (33 had left ventricular systolic dysfunction [LVSD]); 29 had right ventricular impairment; 69 had valvular dysfunction; 6 had symptomatic atrial fibrillation; and 2 had pericardial effusion (figure 2). At study end, HF prevalence for both primary care groups increased by 0.2% (from 0.9% to 1.1%).Conclusions One in four patients prescribed a loop diuretic who are not on the HF register have HF. One in twenty have LVSD. Lack of accurate coding is common. Patients being prescribed a loop diuretic should be screened for HF.Abstract 206 Figure 1Summary of patient journey in the study. ‘BNP’ referred to NT-proBNPAbstract 206 Figure 2A visual summary of the study. *Firm indication is defined as either HF, chronic kidney disease, chronic liver disease, hypertension, or other acute volume overload state. AF:atrial fibrillation; CKD:chronic kidney disease; GP:general practitioner; HF:heart failure; HTN:hypertension; LVDD:left ventricular diastolic dysfunction; LVSD:left ventricular systolic dysfunction; NT-proBNP:N-terminal pro-B-type natriuretic peptide; PH:pulmonary hypertension; RVSD:right ventricular systolic dysfunction",
  "authors": [
    {
      "affiliations": [
        "Castle Hill Hospital, Cottingham, United Kingdom",
        "Hull York Medical School, Hull, United Kingdom"
      ],
      "name": "Elton Luo"
    },
    {
      "affiliations": [
        "Castle Hill Hospital, Cottingham, United Kingdom",
        "Hull York Medical School, Hull, United Kingdom"
      ],
      "name": "Joe Cuthbert"
    },
    {
      "affiliations": [
        "Greengates Medical Group, East Yorkshire, United Kingdom"
      ],
      "name": "Stephanie Lomax"
    },
    {
      "affiliations": [
        "Hull Modality Partnership, Hull, United Kingdom"
      ],
      "name": "James Moult"
    },
    {
      "affiliations": [
        "Hull Modality Partnership, Hull, United Kingdom"
      ],
      "name": "Kamil Krajewski"
    },
    {
      "affiliations": [
        "Castle Hill Hospital, Cottingham, United Kingdom"
      ],
      "name": "Andrew Clark"
    }
  ],
  "title": "206 Where is all the heart failure? A community study",
  "uid": "21e6f88b-b074-5246-a6bf-0b38a1844667"
}