{
  "abstract": "Introduction Despite therapeutic advances, unplanned hospital admissions for heart failure (HF) remain high. Approximately 80% of patients receive a HF diagnosis during an inpatient admission, often after prolonged symptomatic periods without engagement with healthcare services. Hard-to-reach populations, particularly in areas of socioeconomic deprivation and ethnic diversity, are less likely to access care, contributing to increased morbidity and mortality. Hounslow has among the highest rates of years of life lost under the age of 75 due to cardiovascular disease (CVD) in England, alongside elevated HF hospitalisation rates. This project aims to address these disparities through proactive, community-based screening.We aim to characterise echocardiographic findings in individuals with raised N-terminal pro-B-type natriuretic peptide (NT-proBNP) identified through a community HF outreach screening programme.Methods An integrated primary and secondary care team launched a pilot HF outreach project in June 2020 in partnership with the Healthy Hounslow service. An electronic search identified individuals at potential risk of HF. Community screening was delivered via roaming clinics, targeting areas of high deprivation and health inequality. Patients then attended screening clinics, where NT-proBNP testing was performed. Individuals with elevated NT-proBNP were referred for transthoracic echocardiography (TTE).Results One hundred patients attended community screening clinics across Index of Multiple Deprivation deciles 2–6. Of whom 11 (11%) had elevated NT-proBNP. Ten patients underwent echocardiography and were included in this analysis. The median age was 67 years. 80% were in sinus rhythm and 20% in atrial fibrillation. NT-proBNP levels were elevated across the cohort (median 762 pg/mL).Left ventricular systolic function (LVSF) was preserved (ejection fraction [EF] >50%) in nine patients (90%). Diastolic dysfunction was present in six patients (60%) and left ventricular hypertrophy in two patients (20%). Right ventricular size and systolic function were largely normal, and valvular disease was predominantly mild. One patient had severe aortic stenosis (AS), and one had a bicuspid aortic valve with both moderate aortic regurgitation (AR) and aortic root dilatation.Conclusion NT-proBNP-based community screening predominantly identified individuals with left ventricular diastolic dysfunction. Despite significantly elevated biomarker levels, systolic dysfunction was uncommon, emphasising the importance of echocardiography for accurate phenotyping of suspected HF in community settings.Importantly, echocardiography also identified alternative clinically significant pathology, including severe AS and bicuspid aortic valve disease with moderate AR and associated aortopathy. These findings highlight the value of an outreach-based screening pathway in underserved populations, not only for HF evaluation but also for identifying actionable CVD earlier.",
  "authors": [
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Zak Rossaye"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Angela Murphy"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Reda Abuhassan"
    },
    {
      "affiliations": [
        "Little Park Surgery, London, United Kingdom"
      ],
      "name": "Nasrullah Sultani"
    },
    {
      "affiliations": [
        "West London NHS Trust, London, United Kingdom"
      ],
      "name": "Jessica Bennett"
    },
    {
      "affiliations": [
        "Little Park Surgery, London, United Kingdom"
      ],
      "name": "Mark Remedios"
    },
    {
      "affiliations": [
        "Imperial College London, London, United Kingdom"
      ],
      "name": "Ahmed El-Medany"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom",
        "Imperial College London, London, United Kingdom",
        "National Heart and Lung Institute, London, United Kingdom"
      ],
      "name": "Sadia Khan"
    }
  ],
  "title": "479 A community heart failure outreach pathway identifying meaningful pathology in underserved populations",
  "uid": "67e1346f-008e-591f-bc42-cd37a15cd29d"
}