PORTHOS - PORTuguese Heart Failure Observational Study

Study Overview
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Brief Summary
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This study aims to determine the prevalence of heart failure in the resident population in mainland Portugal aged 50 years or above, using a contemporary, guideline-based diagnostic approach, to optimize patient management and improve strategic healthcare decision-making

Detailed Description
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The contemporary prevalence of heart failure in Portugal is largely unknown and may differ from that reported in early studies, which were conducted in the late 1990s-early 2000s with the diagnostic techniques available at the time and did not include neither advanced echocardiographic parameters nor natriuretic peptides measurements. Thus, a large and representative study is needed to address knowledge gaps on the epidemiology, characteristics and burden of heart failure in Portugal. The study aims to determine the prevalence of global heart failure, as well as heart failure subtypes. It also aims to assess the distribution of comorbidities among patients with heart failure, as well as patients' health-related quality of life. The Investigators will conduct a population-based study with a three-stage design approach, enrolling 5616 subjects aged 50 years or above, randomly selected through multi-stage sampling, using the National Health Service as reference: PHASE 0 - Participant selection/enrollment through phone call; PHASE 1 - Screening (NT-proBNP levels determination), health-related quality of life evaluation and sociodemographic characterization; PHASE 2 - Confirmatory assessment with a 12-lead electrocardiography, comprehensive transthoracic echocardiography, extended symptoms assessment and biomarkers assessment; PHASE 3 - Heart failure with preserved ejection fraction exertion testing through a non-invasive echocardiographic diastolic stress test.

Official Title
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PORTHOS - PORTuguese Heart Failure Observational Study: a Nationwide Epidemiological Study on Heart Failure and Asymptomatic Left Ventricle Systolic Dysfunction Based on Contemporary Diagnostic Tools

Conditions
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Heart Failure

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Community-dwelling citizens living in Mainland Portugal; Registration in a primary care centre; Age ≥50 years at recruitment; Voluntary signed informed consent. Exclusion criteria: Living in institutions (e.g., nursing homes, prisons, military facilities, hospitals); Non-Portuguese speakers; Reduced physical and/or cognitive ability hampering participation (e.g., blindness, deafness, or cognitive impairment).

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of HF among the mainland resident Portuguese population aged 50 or above. | Prevalence of HF among the mainland resident Portuguese population aged 50 or above. | Between March 2022 and March 2023 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Age- and gender-specific prevalence of HF among the Portuguese population. | Age- and gender-specific prevalence of HF among the Portuguese population. | Between March 2022 and March 2023 | 
| Heart Failure reduced Ejection Fraction phenotype prevalence. | Heart Failure reduced Ejection Fraction phenotype prevalence. | Between March 2022 and March 2023 | 
| Heart Failure mildly reduced Ejection Fraction phenotype prevalence | Heart Failure mildly reduced Ejection Fraction phenotype prevalence | Between March 2022 and March 2023 | 
| Heart Failure preserved Ejection Fraction phenotype prevalence. | Heart Failure preserved Ejection Fraction phenotypes prevalence. | Between March 2022 and March 2023 | 
| Prevalence of asymptomatic NT-proBNP elevation. | Prevalence of asymptomatic NT-proBNP elevation. | Between March 2022 and March 2023 | 
| Prevalence of Pre-HF, as defined by the HF universal definition 2, in patients with asymptomatic NT-proBNP elevation. | Prevalence of Pre-HF, as defined by the HF universal definition 2, in patients with asymptomatic NT-proBNP elevation. | Between March 2022 and March 2023 | 
| Prevalence of comorbidities among Portuguese HF patients | Prevalence of comorbidities among Portuguese HF patients, namely: CHD, previous MI, hypertension, obesity, DM, VHD, AF, CKD, COPD, OSA; | Between March 2022 and March 2023 | 
| Prevalence of comorbidities among patients with HFrEF, HFmrEF, and HFpEF phenotypes. | Prevalence of comorbidities among patients with HFrEF, HFmrEF, and HFpEF phenotypes, namely: CHD, previous MI, hypertension, obesity, DM, VHD, AF, CKD, COPD, OSA. | Between March 2022 and March 2023 | 
| Health-related quality of life 5-level Euro Quality of life-5D version (EQ-5D-5L) | Health-related quality of life 5-level Euro Quality of life-5D version (EQ-5D-5L) consists of 2 pages: the descriptive system (EQ-5D) and the visual analogue scale (EQ VAS). EQ-5D comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression; each one has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. The patient is asked to indicate his/her health state. This decision results in a 1-digit number that expresses the level selected for that dimension. The digits for the 5 dimensions can be combined into a 5-digit number that describes the patient's health state. The EQ VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' (100) and 'The worst health you can imagine' (0). | Between March 2022 and March 2023 | 
| Health-related quality of life (Kansas City Cardiomyopathy Questionnaire - KCCQ) | Health-related quality of life (Kansas City Cardiomyopathy Questionnaire - KCCQ). The predictor was the annually updated KCCQ score. The KCCQ is a validated instrument to assess health status among persons with heart failure. The self-administered questionnaire includes 23-items which quantify the importance of dyspnea, fatigue, and edema on physical, social, and emotional functions. The responses are categorized under 3 subscales (symptom burden, physical limitation and quality of life) with a range of possible subscale scores from 0 to 100, with 100 representing the least burden of symptoms. The total KCCQ score represents the mean of the three subscale scores. | Between March 2022 and March 2023 | 
| Association between health-related quality of life questionnaire (EQ-5D-5L) results and the HF phenotype. | Association between health-related quality of life questionnaire (EQ-5D-5L) results and the HF phenotype. | Between March 2022 and March 2023 | 
| Association between health-related quality of life questionnaire (KCCQ) results and the HF phenotype. | Association between health-related quality of life questionnaire (KCCQ) results and the HF phenotype. | Between March 2022 and March 2023 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prevalence, Heart failure