Improvement Initiatives in the Diagnostic Process of Heart Failure: A Scoping Review

Diego Aguiar¹Rafael Gonzalez-Manzanares^2,3,4Manuel Raya-Cruz⁵Juan Carlos Romero-Vigara^6,7Cristina Salazar Mosteiro⁸Alejandro J. García Díaz⁹Victoria Gonzalez Pastor⁹Amaia Ugarte de Miguel⁹Eduard Ródenas-Alesina^10,11*

• ¹Navarra University Hospital, Pamplona, Navarra, Spain, Pamplona, Spain
• ²Hospital Universitario Reina Sofia, Córdoba, Spain
• ³Instituto Maimonides de Investigacion Biomedica de Cordoba, Córdoba, Spain
• ⁴CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain, Madrid, Spain
• ⁵Hospital Universiario de Jaen, Jaén, Spain
• ⁶Alfajarín Primary Care Center (Zaragoza), Health Service of Aragon, Spain, Zaragoza, Spain
• ⁷Instituto de Investigacion Sanitaria Aragon, Zaragoza, Spain
• ⁸Hospital Nuestra Senora del Prado, Talavera de la Reina, Spain
• ⁹AstraZeneca Farmaceutica Spain SA, Madrid, Spain
• ¹⁰Department of Cardiology, Vall d'Hebron University Hospital, Catalan Health Institute, Barcelona, Spain
• ¹¹Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares, Madrid, Spain

Heart failure (HF) poses a substantial global health burden due to its high prevalence and severe clinical outcomes. Early diagnosis is critical to optimize management and reduce the economic impact of HF. This scoping review consolidates existing knowledge on strategies to improve HF diagnosis, emphasizing the utility of biomarkers, imaging techniques, artificial intelligence (AI), and care pathways. A systematic search of PubMed/Medline and Scopus databases identified 198 relevant studies published since 2010, focusing on adult populations without a prior HF diagnosis. The inclusion criteria centered on initiatives aimed at enhancing diagnostic processes. Results indicate that biomarkers, particularly natriuretic peptides such as N-terminal prohormone of BNP (NT-proBNP), are central to early HF detection, showing high sensitivity. Emerging biomarkers, like microRNAs, offer potential for improved diagnostic accuracy. Imaging techniques, including echocardiography and lung ultrasound, remain primary tools for assessing cardiac function, while AI applications in imaging and electronic health records represent a rapidly evolving field. These tools show promising potential for early identification of HF patients, although most require further validation and standardization before routine clinical implementation. Care pathways emphasizing high-resolution consultations and integrated diagnostic tools enable prompt HF diagnosis, crucial for initiating early treatments. By implementing these diagnostic strategies, particularly in high-risk populations such as those with comorbid conditions, there is potential to significantly advance patient outcomes and healthcare resource management. Nevertheless, it is essential to translate these advances into clinical practice, considering healthcare context and socioeconomic limitations, and promoting international consensus to ensure their global adoption. In conclusion, ongoing research and refinement of these diagnostic tools are imperative to effectively address the growing challenge of HF.