Feasibility of the cardiac output response to stress test in suspected heart failure patients

Sarah J. Charman; Nduka C. Okwose; Clare J. Taylor; Kristian Bailey; Ahmet Fuat; Arsen Ristic; Jonathan Mant; Christi Deaton; Petar M. Seferovic; Andrew J.S. Coats; F D Richard Hobbs; Guy A. Macgowan; Djordje G. Jakovljevic

doi:10.1093/fampra/cmab184

Feasibility of the cardiac output response to stress test in suspected heart failure patients

Sarah J. Charman, Nduka C. Okwose, Clare J. Taylor, Kristian Bailey, Ahmet Fuat, Arsen Ristic, Jonathan Mant, Christi Deaton, Petar M. Seferovic, Andrew J.S. Coats, F D Richard Hobbs, Guy A. Macgowan, Djordje G. Jakovljevic^*

^*Corresponding author for this work

Applied Health Research

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Abstract

Background: Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited.

Objectives: (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction.

Methods: Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases.

Results: A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m², P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m², P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m², P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m², P = 0.03) than HFpEF patients.

Conclusion: The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.

Original language	English
Pages (from-to)	805-812
Number of pages	8
Journal	Family Practice
Volume	39
Issue number	5
Early online date	27 Jan 2022
DOIs	https://doi.org/10.1093/fampra/cmab184
Publication status	Published - Oct 2022

Bibliographical note

Funding:
This study was funded by the UK Medical Research Council Confidence in Concept Scheme grant to DGJ (BH161161). At the time of the study DGJ was supported by the UK Research Councils’ Newcastle Centre for Ageing and Vitality (L016354). SJC, NCO, GAM, and DGJ are supported by the European Horizon 2020 Research and Innovation programme under the grant agreement number 777204. The views expressed are those of the authors and not necessarily those of the Medical Research Council. CJT is a NIHR Academic Clinical Lecturer. FDRH acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC, and Harris Manchester College, Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders of the study had no role in study design or in data collection, analysis, or interpretation.

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press.

Keywords

cardiac output
feasibility
general practice
heart failure
primary care

ASJC Scopus subject areas

General Medicine

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Cite this

@article{096a744ba73448c091e784e6bd042584,

title = "Feasibility of the cardiac output response to stress test in suspected heart failure patients",

abstract = "Background: Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. Objectives: (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. Methods: Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. Results: A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. Conclusion: The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.",

keywords = "cardiac output, feasibility, general practice, heart failure, primary care",

author = "Charman, {Sarah J.} and Okwose, {Nduka C.} and Taylor, {Clare J.} and Kristian Bailey and Ahmet Fuat and Arsen Ristic and Jonathan Mant and Christi Deaton and Seferovic, {Petar M.} and Coats, {Andrew J.S.} and Hobbs, {F D Richard} and Macgowan, {Guy A.} and Jakovljevic, {Djordje G.}",

note = "Funding: This study was funded by the UK Medical Research Council Confidence in Concept Scheme grant to DGJ (BH161161). At the time of the study DGJ was supported by the UK Research Councils{\textquoteright} Newcastle Centre for Ageing and Vitality (L016354). SJC, NCO, GAM, and DGJ are supported by the European Horizon 2020 Research and Innovation programme under the grant agreement number 777204. The views expressed are those of the authors and not necessarily those of the Medical Research Council. CJT is a NIHR Academic Clinical Lecturer. FDRH acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC, and Harris Manchester College, Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders of the study had no role in study design or in data collection, analysis, or interpretation. Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Oxford University Press.",

year = "2022",

month = oct,

doi = "10.1093/fampra/cmab184",

language = "English",

volume = "39",

pages = "805--812",

journal = "Family Practice",

issn = "0263-2136",

publisher = "Oxford University Press",

number = "5",

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TY - JOUR

T1 - Feasibility of the cardiac output response to stress test in suspected heart failure patients

AU - Charman, Sarah J.

AU - Okwose, Nduka C.

AU - Taylor, Clare J.

AU - Bailey, Kristian

AU - Fuat, Ahmet

AU - Ristic, Arsen

AU - Mant, Jonathan

AU - Deaton, Christi

AU - Seferovic, Petar M.

AU - Coats, Andrew J.S.

AU - Hobbs, F D Richard

AU - Macgowan, Guy A.

AU - Jakovljevic, Djordje G.

N1 - Funding: This study was funded by the UK Medical Research Council Confidence in Concept Scheme grant to DGJ (BH161161). At the time of the study DGJ was supported by the UK Research Councils’ Newcastle Centre for Ageing and Vitality (L016354). SJC, NCO, GAM, and DGJ are supported by the European Horizon 2020 Research and Innovation programme under the grant agreement number 777204. The views expressed are those of the authors and not necessarily those of the Medical Research Council. CJT is a NIHR Academic Clinical Lecturer. FDRH acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC, and Harris Manchester College, Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders of the study had no role in study design or in data collection, analysis, or interpretation. Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press.

PY - 2022/10

Y1 - 2022/10

N2 - Background: Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. Objectives: (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. Methods: Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. Results: A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. Conclusion: The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.

AB - Background: Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. Objectives: (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. Methods: Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. Results: A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. Conclusion: The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.

KW - cardiac output

KW - feasibility

KW - general practice

KW - heart failure

KW - primary care

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JF - Family Practice

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Feasibility of the cardiac output response to stress test in suspected heart failure patients

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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