Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study
Background Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome in which signs and symptoms of heart failure (HF) occur despite a normal left ventricular ejection fraction. Transthoracic echocardiography (TTE) is the first-line imaging modality but disparities in pat...
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BMJ Publishing Group
2025-03-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003063.full |
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| author | Clare J Taylor Rosita Zakeri Maria F Paton Carys Barton Andrew Potter Resham Baruah Shaun Robinson Raj Thakkar Nick Hartshorne-Evans Geraint H Jenkins |
| author_facet | Clare J Taylor Rosita Zakeri Maria F Paton Carys Barton Andrew Potter Resham Baruah Shaun Robinson Raj Thakkar Nick Hartshorne-Evans Geraint H Jenkins |
| author_sort | Clare J Taylor |
| collection | DOAJ |
| description | Background Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome in which signs and symptoms of heart failure (HF) occur despite a normal left ventricular ejection fraction. Transthoracic echocardiography (TTE) is the first-line imaging modality but disparities in patient pathways across the UK can lead to delayed diagnosis and treatment. We aimed to develop and validate a consistent, clinically appropriate and practical approach for reporting the echocardiographic suspicion of HFpEF.Methods Using the Delphi method, a steering group of nine UK experts identified key domains for discussion and generated consensus statements relevant to the echocardiographic detection of HFpEF. Using a four-point Likert scale, a survey including all statements was disseminated among a wider audience of healthcare professionals to determine agreement. A consensus threshold of 75% agreement was defined as ‘strong’ and ≥90% as ‘very strong’.Results A total of 34 consensus statements were generated in seven domains: (1) challenges in the system approach to HFpEF; (2) enhancing referral for specialist review including echocardiography; (3) confidence in using a summary statement in an echo report; (4) identifying HFpEF and its underlying aetiology; (5) HF awareness, training and education; (6) refining multidisciplinary team roles in decision-making; (7) optimising patient experience.135 UK specialists experienced in managing HF participated in the survey, including physiologists/clinical scientists (n=43), HF specialist nurses (n=35), cardiologists (n=34), general practitioners (n=12), pharmacists (n=4) and others (n=7). 20 of 34 (59%) statements achieved very strong agreement, 10 of 34 (29%) achieved strong agreement and 4 of 34 (12%) did not meet the consensus threshold.Conclusions Diagnosis of HFpEF requires access to essential diagnostic tools. Establishing standardised pathways for specialist assessment and referral, including TTE reporting of HFpEF, may help eliminate diagnostic delays and geographical disparities. Further education and awareness are crucial for improving detection rates, prompt referral and patient experience. |
| format | Article |
| id | doaj-art-570692667b4a4ee1be92013dc3b66e39 |
| institution | DOAJ |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-570692667b4a4ee1be92013dc3b66e392025-08-20T02:50:26ZengBMJ Publishing GroupOpen Heart2053-36242025-03-0112110.1136/openhrt-2024-003063Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus studyClare J Taylor0Rosita Zakeri1Maria F Paton2Carys Barton3Andrew Potter4Resham Baruah5Shaun Robinson6Raj Thakkar7Nick Hartshorne-Evans8Geraint H Jenkins9Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UKSchool of Cardiovascular Medicine & Metabolic Sciences, King’s College London, London, UKLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UKImperial College Healthcare NHS Trust, London, UKWhaddon Medical Centre, Milton Keynes, UKAstraZeneca UK Limited, London, UKImperial College Healthcare NHS Trust, London, UKAstraZeneca UK Limited, London, UKPumping Marvellous Foundation, Preston, UKRegional Cardiac Centre, Morriston Cardiac Centre, Swansea Bay University Health Board, Swansea, UKBackground Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome in which signs and symptoms of heart failure (HF) occur despite a normal left ventricular ejection fraction. Transthoracic echocardiography (TTE) is the first-line imaging modality but disparities in patient pathways across the UK can lead to delayed diagnosis and treatment. We aimed to develop and validate a consistent, clinically appropriate and practical approach for reporting the echocardiographic suspicion of HFpEF.Methods Using the Delphi method, a steering group of nine UK experts identified key domains for discussion and generated consensus statements relevant to the echocardiographic detection of HFpEF. Using a four-point Likert scale, a survey including all statements was disseminated among a wider audience of healthcare professionals to determine agreement. A consensus threshold of 75% agreement was defined as ‘strong’ and ≥90% as ‘very strong’.Results A total of 34 consensus statements were generated in seven domains: (1) challenges in the system approach to HFpEF; (2) enhancing referral for specialist review including echocardiography; (3) confidence in using a summary statement in an echo report; (4) identifying HFpEF and its underlying aetiology; (5) HF awareness, training and education; (6) refining multidisciplinary team roles in decision-making; (7) optimising patient experience.135 UK specialists experienced in managing HF participated in the survey, including physiologists/clinical scientists (n=43), HF specialist nurses (n=35), cardiologists (n=34), general practitioners (n=12), pharmacists (n=4) and others (n=7). 20 of 34 (59%) statements achieved very strong agreement, 10 of 34 (29%) achieved strong agreement and 4 of 34 (12%) did not meet the consensus threshold.Conclusions Diagnosis of HFpEF requires access to essential diagnostic tools. Establishing standardised pathways for specialist assessment and referral, including TTE reporting of HFpEF, may help eliminate diagnostic delays and geographical disparities. Further education and awareness are crucial for improving detection rates, prompt referral and patient experience.https://openheart.bmj.com/content/12/1/e003063.full |
| spellingShingle | Clare J Taylor Rosita Zakeri Maria F Paton Carys Barton Andrew Potter Resham Baruah Shaun Robinson Raj Thakkar Nick Hartshorne-Evans Geraint H Jenkins Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study Open Heart |
| title | Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study |
| title_full | Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study |
| title_fullStr | Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study |
| title_full_unstemmed | Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study |
| title_short | Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study |
| title_sort | echocardiography reporting in heart failure with preserved ejection fraction delphi consensus study |
| url | https://openheart.bmj.com/content/12/1/e003063.full |
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