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. 2024 Aug 8;25(1):288.
doi: 10.1186/s12875-024-02549-4.

Diagnostic and therapeutic challenges for PCPs regarding heart failure with preserved ejection fraction and obesity: results of an online internet-based survey

Carlos Campos  1 , Melissa Magwire  2 , Javed Butler  3   4 , Anthony Hoovler  5 , Anup Sabharwal  5 , Sanjiv J Shah  6
Affiliations

Diagnostic and therapeutic challenges for PCPs regarding heart failure with preserved ejection fraction and obesity: results of an online internet-based survey

Carlos Campos et al. BMC Prim Care. .

Abstract

Background: Obesity (body mass index ≥ 30 kg/m2) is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and affects most patients with HFpEF. Patients living with obesity may experience delays in HFpEF diagnosis and management. We aimed to understand the clinical journey of patients with obesity and HFpEF and the role of primary care providers (PCPs) in diagnosing and managing patients with both conditions.

Methods: An anonymous, US population-based online survey was conducted in September 2020 among 114 patients with self-reported HFpEF and obesity and 200 healthcare providers, 61 of whom were PCPs who treat patients with HFpEF and obesity.

Results: Half of patients (51%) with HFpEF reported waiting an average of 11 months to discuss their symptoms with a PCP; 11% then received their diagnosis from a PCP. PCPs initiated treatment and oversaw the management of HFpEF only 35% of the time, and 44% of PCPs discussed obesity treatment medication options with their patients. Only 20% of PCPs indicated they had received formal obesity management training, and 79% of PCPs indicated they would be interested in obesity management training and support.

Conclusion: PCPs could play a valuable role in addressing obesity and referring patients with obesity and signs and symptoms of HFpEF to cardiologists. Increased awareness of HFpEF and its link to obesity may help PCPs more quickly identify and diagnose their patients with these conditions.

Keywords: Heart failure; Obesity management; Primary Health Care; Surveys and questionnaires.

Plain language summary

Heart failure with preserved ejection fraction (HFpEF) is a common form of heart failure. Many patients who have HFpEF also have obesity or excess weight. We wanted to understand the medical experience of patients with HFpEF and obesity and the role that primary care providers (PCPs) play in managing patients with these diseases. We surveyed 114 patients with HFpEF and obesity and 200 healthcare providers who treat patients with HFpEF and obesity, 61 of whom were PCPs. One-quarter of patients had a major heart-related event that led to their HFpEF diagnosis. Half of the patients said they had an initial discussion about HFpEF symptoms with a PCP, but only one in ten were diagnosed by a PCP. Few PCPs said they received obesity management training, but most were interested in receiving more obesity management training and support. PCPs play an important role in organizing care for patients with HFpEF and obesity. However, there is room to improve HFpEF awareness and access to obesity management tools and strategies among PCPs.

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Conflict of interest statement

CC is a speaker for Novo Nordisk, Lilly, and Boeringher Ingelheim (BI). He serves on the advisory board and as a consultant for Novo Nordisk, Lilly, BI and Sanofi. MM is a Consultant/Advisory Board Member for Novo Nordisk and Boehringer Ingelheim. JB is a consultant to Abbott, American Regent, Amgen, Applied Therapeutic, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiac Dimension, Cardior, CVRx, Cytokinetics, Edwards, Element Science, Innolife, Impulse Dynamics, Imbria, Inventiva, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Roche, Sequana, SQ Innovation, 3live, and Vifor. AH and AS are employees of and shareholders in Novo Nordisk Inc. (Plainsboro, NJ, USA).SJS reports receiving research grants from the National Institutes of Health (U54 HL160273, R01 HL127028, R01 HL140731, and R01 HL149423), AstraZeneca, Corvia Medical, and Pfizer; and consulting fees from Abbott, AstraZeneca, Alleviant, Amgen, Aria CV, Axon Therapies, Bayer, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cyclerion, Cytokinetics, Edwards Lifesciences, Eidos, Imara, Impulse Dynamics, Intellia, Ionis, Lilly, Merck, Metabolic Flux, MyoKardia, NGM Biopharmaceuticals, Novartis, Novo Nordisk, Pfizer, Prothena, Regeneron, Rivus, Sardocor, Shifamed, Tenax, Tenaya, Ultromics, and United Therapeutics.

Figures

Fig. 1
Fig. 1
Most common pathway for patients with HFpEF and obesity, which includes patients who had initial discussions with HCPs, followed by a HFpEF diagnosis, and ultimately treatment for HFpEF. Abbreviations: SD, standard deviation; HCPs, healthcare providers; HFpEF, heart failure with preserved ejection fraction; PCP, primary care provider
Fig. 2
Fig. 2
Among the patients with HFpEF and obesity whom PCPs personally diagnose with HFpEF, the mean percentage of patients in each presented scenario where HFpEF symptoms are first discussed. Abbreviations: HFpEF, heart failure with preserved ejection fraction; PCP, primary care provider
Fig. 3
Fig. 3
Percentage of PCPs reporting the types of treatments they personally prescribe or recommend to patients with HFpEF and obesity for the treatment of HFpEF symptoms (for both newly diagnosed patients and ongoing treatment/management). Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blockers; HCP, healthcare professional; HFpEF, heart failure with preserved ejection fraction; PCP, primary care provider
Fig. 4
Fig. 4
PCPs’ agreement with statements about their role and the roles of their patients in weight loss management. Percentage of respondents indicating their level of agreement was a 6 or a 7 where “1” meant “Do not agree at all” and “7” meant “Completely agree.” Abbreviations: HFpEF, heart failure with preserved ejection fraction; PCP, primary care provider
Fig. 5
Fig. 5
PCPs’ and patients’ perceptions of the impact obesity has on HFpEF development, progression, and severity. Percentage of respondents indicating the level of impact was a 6 or 7 where “1” means “Doesn’t impact at all” and “7” means “Greatly impacts.” Abbreviations: HFpEF, heart failure with preserved ejection fraction; PCP, primary care provider
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