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. 2025 Mar 28;12(1):e003063.
doi: 10.1136/openhrt-2024-003063.

Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study

Maria F Paton  1   2 , Carys Barton  3 , Resham Baruah  4 , Nick Hartshorne-Evans  5 , Geraint H Jenkins  6 , Andrew Potter  7 , Shaun Robinson  3 , Raj Thakkar  4   8 , Rosita Zakeri  9 , Clare J Taylor  10
Affiliations

Echocardiography reporting in heart failure with preserved ejection fraction: Delphi consensus study

Maria F Paton et al. Open Heart. .

Abstract

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.

Keywords: Cardiac Imaging Techniques; Echocardiography; HEART FAILURE; Health Services.

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Conflict of interest statement

Competing interests: CB has received speaker and consultancy fees from AstraZeneca, Pharmacosmos, Medtronic, Pfizer. CJJT has received occasional consultancy and speaker fees from AstraZeneca, Roche and Bayer. GHJ has received consultancy, speaker fees or sponsored attendance at meetings from AstraZeneca, Boerrhinger-Ingelheim, Amarin, Novartis, Novo-Nordisk, Pfizer, Janssen, Vifor Pharma, Pharmacosmos, Relyspa, Amicus. MFP is a Trustee of the British Society of Echocardiography and has received consultancy or speaker fees from Medtronic, Abbott, AstraZeneca and GE Healthcare. NH-E has received consultancy, speaker fees or sponsored attendance at meetings Roche, Pharmacosmos, Novartis, Medtronic, AstraZeneca. RB was employed by AstraZeneca UK during the study and is currently affiliated with Novo Nordisk. RT has been employed by AstraZeneca UK during the study. RZ is supported by a National Institute for Healthcare Research (NIHR) Advanced Fellowship award (NIHR302961) and has received consultancy and speaker fees from AstraZeneca. SR has received speaker and consultancy fees from AstraZeneca.

Figures

Figure 1
Figure 1. Modified Delphi study stages and objectives.
Figure 2
Figure 2. Geographic location of respondents. Darker colours represent locations with a higher number of respondents.
Figure 3
Figure 3. Consensus level for all statements. The 75% threshold for consensus is represented as a green line. The blue line shows 90% agreement.
See this image and copyright information in PMC

References

    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–726. doi: 10.1093/eurheartj/ehab368. - DOI - PubMed
    1. Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail . 2021;23:352–80. doi: 10.1002/ejhf.2115. - DOI - PubMed
    1. National Institute for Health and Care Excellence (NICE) Chronic heart failure in adults: diagnosis and management nice guideline [NG106] [12-Sep-2018];2025 www.nice.org.uk/guidance/ng106 Available. accessed. - PubMed
    1. Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023;81:1835–78. doi: 10.1016/j.jacc.2023.03.393. - DOI - PubMed
    1. Jasinska-Piadlo A, Campbell P. Management of patients with heart failure and preserved ejection fraction. Heart. 2023;109:874–83. doi: 10.1136/heartjnl-2022-321097. - DOI - PMC - PubMed