Heart failure patients show no warning signs before deadly diagnosis
A Swedish study of 902 patients who died within 90 days of heart failure diagnosis found no significant increase in hospital or doctor visits before diagnosis — suggesting current healthcare systems miss critical intervention windows. The finding has major implications for early-warning systems and how health systems allocate resources for at-risk populations.
Originaltitel: Healthcare utilization patterns prior to a first heart failure diagnosis in a 90 day mortality cohort: A retrospective cohort study.
Tidigt förebyggande av hjärtsvikt är begränsat av en mycket kort fönster för upptäckt. Svenska forskare vid Region Halland studerade 902 patienter (medelålder 85 år) som fick diagnosen hjärtsvikt under 2013–2019 och avled inom 90 dagar. Genom att analysera vårdutnyttjandet 12 veckor innan diagnos fann de att patientbesöken låg stabilt lågt fram till sista två veckorna. Då ökade antalet veckovisa kontakter från 0,42 till 1,77 (p < 0,001), primärvårdsbesöken från 0,30 till 0,72. Biomarkören NT-proBNP låg på medelvärdet 11 210 ng/L, och 65 procent saknade registrerad ekokardiografi. Fynden innebär att rutinmässiga förebyggande insatser i ordinär vård blir svåra att implementera — vårdsystemet får endast två veckors förvarning före diagnos. Inköpschefer och klinikledare bör därför fokusera på triagering och riskstratifiering snarare än på screening i lågriskgrupper.
BACKGROUND: Early recognition of emerging heart failure prior to diagnosis could offer an opportunity for prevention-focused care, but it remains unclear whether healthcare seeking patterns before diagnosis indicate an earlier window for intervention. The objective was to determine if changes in utilization appeared during the 12-week pre-diagnosis period preceding a first diagnosis of heart failure with poor short-term prognosis. METHODS: A retrospective population-based study in Region Halland, Sweden, used the Regional Healthcare Information Platform to identify persons aged 40-90 years with incident heart failure during 2013 to 2019 who had died within 90 days. Encounters across inpatient and outpatient care settings, estimated glomerular filtration rate, N-terminal pro B type natriuretic peptide (NT-proBNP), echocardiography status and comorbidities were retrieved. Repeated measures analysis assessed trends in weekly visits during the 12-week lookback, with covariance analysis adjusted for age, sex, hypertension, ischemic heart disease and diabetes. RESULTS: The cohort included 902 individuals, mean age 85 years, 52% women. Echocardiography was not registered in 65%. Mean NT-proBNP measured 11,210 ng/L. The total average number of visits per week increased from 0.42 at week minus 12 to 1.77 at week 0 (p < 0.001). Primary care visits had increased from 0.30 to 0.72 (p < 0.001). Adjustments did not alter the pattern. No consistent early rise in visits appeared before the final two weeks. CONCLUSIONS: In this high-mortality population, healthcare utilization remained low and unchanged until a sharp rise immediately before diagnosis, indicating a narrow and late window for preventive action, which limits the feasibility of preventive intervention in routine care.