Redefining the detection of heart failure

The challenge

Heart failure (HF) is a prevalent problem, with approximately 1-3% of the population affected in developed countries.[1] This number is expected to increase with the growing aging population, as one of the biggest risk factors is being over 65 years of age. While it is a prevalent condition, diagnosis typically happens late in the disease, and often in the hospital setting. Early diagnosis of HF enables access to a wider range of treatment options, which not only alleviate symptoms but may also slow down disease progression.

However, HF can be difficult to detect in early stages as its symptoms can be very vague, interpreted as ‘part of aging,’ or patients may even be asymptomatic. As the electrocardiogram (ECG) is typically the first check in the HF diagnosis pathway, the ECG is one of the most common tests to perform both in the specialist setting as well as the primary care setting, as it is fast, affordable, and non-invasive. However, interpreting ECGs can be challenging, even for experts. Although they may hold insights into a patient’s heart health, including indicators related to HF, these indicators may sometimes get missed.

The solution

The Future of Artificial Intelligence Trained for HF detection & Upgrading Latest technology (FAITHFUL) project, lead by Idoven, aims to tackle the challenge of diagnosing heart failure (HF) patients more effectively. The current system of HF diagnosis is reactionary, based on the symptoms that patients exhibit. This approach is inefficient and struggles to keep pace with the increasing number of HF cases, with many of today’s HF patients ending up with a diagnosis only when they are admitted to the hospital to treat their symptoms.

As one of the first steps in the diagnosis pathway is the ECG, the team aims to address this issue by utilising an algorithm on the ECG that can give an HF score, providing primary care physicians (PCPs) with additional information to facilitate more informed decision-making even before symptoms manifest. As ECGs are not only part of the HF diagnostic pathway, but also a routine component of check-ups for individuals at risk of HF, FAITHFUL’s solution enhances the current workflow, changing the current model with new technology and enhancing quality information available to PCPs and to the cardiology department. As the solution is a backend solution, it will seamlessly integrate with the current clinical workflow, providing physicians with reports summarising findings alongside the HF score.

The project team’s goal is to improve outcomes for all stakeholders: providing PCPs with more tools and information to reduce uncertainty in the diagnosis pathway, enabling cardiologists to intervene earlier in the patient journey, resulting in cost savings for payers, and, most importantly, improving patient outcomes and quality of life.

Expected impact

The FAITHFUL project will redefine the detection of heart failure, thereby transforming the lives of those affected by it. Patients will receive a diagnosis earlier, enabling them to commence treatment and adopt lifestyle changes that will significantly enhance their quality of life, as well as their life expectancy.

During the study, the team anticipates that patients diagnosed will maintain a quality of life score close to their baseline.[2]  They also anticipate approximately a 40% decrease in hospitalisations for those diagnosed.[3]  Primary care physicians will be able to offer even higher-quality care to their patients and adopt a more preventative approach to HF, supported by increased confidence in making decisions based on ECG results.

Likewise, cardiologists will have the opportunity to engage in patient care at an earlier stage. Patients will also benefit from earlier diagnosis, as up to 80% of patients are diagnosed in late stage HF and many are diagnosed in the hospital setting only after symptoms have worsened.[4][5] Payers also may benefit significantly by the avoided hospitalisations (the most costly aspect of HF) as well as contribute to the development of a value-based healthcare system. Based on research, FAITHFUL anticipates reducing HF-related costs by 69% for newly diagnosed patients.[3][6][7]

FAITHFUL’s goals are ambitious but focused, supported by a strong consortium that includes world-class healthcare providers, a wide range of patients and payers, as well as organisations advocating for the interests of both patients and providers. Transforming the diagnosis of HF and improving the lives of those affected is no small task, however the FAITHFUL consortium is well equipped to address this crucial healthcare challenge.

External Partners

• Fundación Instituto de Investigación Marqués de Valdecilla (Idival)
• Fundacio TIC Salut Social
• Ilustre Colegio Oficial de Médicos de Madrid (ICOMEM)
• Estonian Health Insurance Fund

References

[1] Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. (2016). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal [Internet]. 2016 Jul 14;37(27):2129–200. Available from: https://doi.org/10.1093/eurheartj/ehw128

[2] Akhtar KH, Agarwal S, Ford L, Zhao YD, Lindenfeld J, Dasari TW. Effect Of Therapies On Quality Of Life In Heart Failure With Reduced Ejection Fraction: A Systematic Review And Meta-analysis. Journal of Cardiac Failure [Internet]. 2023;29(4):659–60. Available from: https://www.sciencedirect.com/science/article/pii/S1071916422010089

[3] Seferović PM, Stoerk S, Filippatos G, Mareev V, Kavoliuniene A, Ristić AD, et al. Organization of heart failure management in European Society of Cardiology member countries: survey of the Heart Failure Association of the European Society of Cardiology in collaboration with the Heart Failure National Societies/Working Groups. European Journal of Heart Failure [Internet]. 2013 Sep 1;15(9):947–59. Available from: https://doi.org/10.1093/eurjhf/hft092

[4] Bottle A, Kim D, Aylin P, Cowie MR, Majeed A, Hayhoe B. Routes to diagnosis of heart failure: observational study using linked data in England. Heart [Internet]. 2018 Apr 1;104(7):600. Available from: http://heart.bmj.com/content/104/7/600.abstract

[5] Bachtiger P, Kelshiker MA, Petri CF, Gandhi M, Shah M, Kamalati T, et al. Survival and health economic outcomes in heart failure diagnosed at hospital admission versus community settings: a propensity-matched analysis. BMJ Health and Care Informatics. 2023 Mar 15;30(1).

[6] Accelerate Change Together Heart Failure Gap Review [Internet]. World Heart Federation; June 2020  [cited 2024 Mar 26]. Available from: https://world-heart-federation.org/resource/accelerate-change-together-heart-failure-gap-review/.

[7] Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, et al. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Services Research. 2020 Dec 1;20(1).