Artificial Intelligence methods for Improved Detection of undiagnosed Heart Failure with Preserved Ejection Fraction (HFpEF)

Background and aim Heart Failure with preserved Ejection Fraction (HFpEF) remains under-diagnosed in clinical practice despite accounting for nearly half of all Heart Hailure (HF) cases. Accurate and timely diagnosis of HFpEF is crucial for proper patient management and treatment. In this study, we explored the potential of natural language processing (NLP) to improve the detection and diagnosis of HFpEF according to the European Society of Cardiology (ESC) diagnostic criteria. Methods In a retrospective cohort study, we used an NLP pipeline applied to the Electronic Health Record (EHR) to identify patients with a clinical diagnosis of HF between 2010-2022. We collected demographic, clinical, echocardiographic and outcome data from the EHR. Patients were categorised according to the left ventricular ejection fraction (LVEF). Those with LVEF ≥ 50% were further categorised based on whether they had a clinician-assigned diagnosis of HFpEF and if not, whether they met the ESC diagnostic criteria. Results were validated in a second, independent centre. Results We identified 8606 patients with HF. Of 3727 consecutive patients with HF and LVEF ≥ 50% on echocardiogram, only 8.3% had a clinician-assigned diagnosis of HFpEF, while 75.4% met ESC criteria but did not have a formal diagnosis of HFpEF. Patients with confirmed HFpEF were hospitalised more frequently; however the ESC criteria group had a higher 5-year mortality, despite being less co-morbid and experiencing fewer acute cardiovascular events. Conclusions This study demonstrates that patients with undiagnosed HFpEF are an at-risk group with high mortality. It is possible to use NLP methods to identify likely HFpEF patients from EHR data who would likely then benefit from expert clinical review and complement the use of diagnostic algorithms. Graphical Abstract Of 3727 consecutive patients with a clinical diagnosis of HF and left ventricular ejection fraction (LVEF) >50% on echocardiogram, only 8.3% had a clinician-assigned diagnosis of HFpEF, while 75.4% met ESC criteria but did not have a formal diagnosis of HFpEF. The two groups had similar rates of hospitalisation however the ESC criteria group had a higher 5-year mortality.