Detecting the Undetected

Affecting millions of people worldwide, heart failure (HF) is a complex clinical syndrome characterized by the insufficiency of the heart to pump and meet the metabolic demands of the body. HF is a significant public health issue that should be at the forefront of everyone's agenda. Recognized as an endpoint for a vast number of conditions of a cardiovascular and non-cardiovascular nature, the prevalence of HF is projected to increase significantly owing to an ageing population, an increase in risk factors and associated long-term conditions such as obesity, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease and hypertension. On the 9th of March 2023 at the 25in25 Summit, convened by the British Society for Heart Failure (BSH), stakeholders hailing from more than 48 health organizations and specialities from the UK, US, Canada and Europe, met, discussed and signed collaboratively a declaration to reduce HF mortality in the first year after diagnosis by 25% in the next 25 years. There is evidence that nearly 50% of patients exhibit symptoms and signs of HF in the 6 months preceding acute HF hospitalization, reflecting crucial missed opportunities for earlier intervention.2, 3 Despite a plethora of life-saving treatments for patients living with HF, the combination of a lack of awareness, late diagnosis, and delayed access to specialists results in 50% of patients dying within a year of admission to hospital, and 40% of newly diagnosed patients dying within a year (NICOR 2021). It is our aim as a Society to empower clinicians and patients with the skills for early detection of suspected HF and to improve prevention, as well as better management of the condition, to reach the afore-mentioned goal of 25in25. The BSH ‘Freedom from Failure – the F-word’ campaign, calling for (self) recognition of common symptoms of HF – fatigue, fighting for breath and fluid build-up (shown in the illustration) and seeking medical advice, is a means to raise awareness of the symptoms and signs of HF. Utilizing the BSH ‘F-word’ campaign, we have outlined some case studies to help recognize symptoms in our patients, ourselves and others. Each of these symptoms (and in combination) presenting in any health setting is an opportunity for early detection of HF. Detecting the undetected is crucial and implementing strategies for early detection can significantly reduce mortality rates and other adverse outcomes in HF. Achieving a 25% reduction in mortality within 25 years will require a concerted, collaborative effort, hence the establishment of the 25in25 Collaborative comprising all those involved in the initiative and the Summit. The theme across Europe for this year's Heart Failure Awareness Week (HFAW), 1–7 May, is ‘Detecting the Undetected’. HF is hidden in plain sight as illustrated in the cases above, it is our collective responsibility to seek it out earlier and treat optimally to give those with HF a better chance.