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Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Heart failure (HF) is frequently diagnosed during hospital admission, often after symptoms have been present for some time. Those diagnosed in hospital typically experience higher mortality reflecting not only possible diagnostic delay but also greater illness severity at presentation. The reasons behind delayed HF diagnosis are multifaceted and complex. This study aimed to achieve consensus on a priority list of patient, clinical, and service-level factors associated with delayed HF diagnosis, and to identify indicators that could support earlier detection of undiagnosed HF in primary care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A three-round modified e-Delphi process involved patients and clinicians from primary and specialist care. Participants rated sociodemographic and clinical factors for their importance in delayed HF diagnosis and clinicians also rated service-level factors and identified indicators of undiagnosed HF. Consensus was defined as two-thirds agreement with stable opinions across rounds (McNemar <jats:italic>p<\/jats:italic>\u2009\u2265\u20090.05). Indicators of undiagnosed HF required additional ranking in the top 5 by &gt;\u200950% of clinicians.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The first survey was completed by 18 patients (67% women, median age 61) and 27 clinicians (67% nurses\/allied health professionals, 33% doctors). Consensus was achieved, comprising 15 factors and 5 indicators. Key sociodemographic factors were patients lacking HF knowledge, lack of access to GP\/cardiologist appointments, symptom confusion, younger age (&lt;\u200950), and learning difficulties. Clinical factors included multimorbidity, respiratory\/mental health conditions, obesity, and depression. Service-level factors included poor HF knowledge, limited N-terminal pro\u2013B-type Natriuretic Peptide (NT-proBNP) testing and echocardiogram access in primary care, and fragmented care. The top 5 indicators of undiagnosed HF included elevated NT-proBNP without referral, loop diuretic use, and overlapping cardiac and respiratory histories.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This study identifies critical factors and indicators that can aid earlier HF diagnosis in primary care. These indicators could be embedded into electronic health record\u2013based alerts and used to support decision-making in primary care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12875-025-03024-4","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T12:07:36Z","timestamp":1760616456000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Developing core indicators for identifying people at risk of delayed heart failure diagnosis"],"prefix":"10.1186","volume":"26","author":[{"given":"K.","family":"Barber","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Bernhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GP","family":"McCann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Squire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CA","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Deaton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Khunti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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All patients provided written consent. Clinicians indicated their willingness to participate through tacit consent, confirmed by email and through completion of the Delphi surveys. All participants were informed of their right to withdraw from the study at any point.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CL has acted as a speaker for Boehringer Ingelheim. KK has acted as a consultant, speaker or received grants for investigator-initiated studies for Astra Zeneca, Bayer, Novo Nordisk, Sanofi-Aventis, Servier, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Pfizer, Roche, Daiichi-Sankyo, Applied Therapeutics, Embecta and Nestle Health Science. CAM has participated on advisory boards\/consulted for AstraZeneca, Boehringer Ingelheim and Lilly Alliance, Novartis and PureTech Health, serves as an advisor for HAYA Therapeutics, has received speaker fees from AstraZeneca, Boehringer Ingelheim and Novo Nordisk, conference attendance support from AstraZeneca, and research support from Amicus Therapeutics, AstraZeneca, Guerbet Laboratories Limited, Roche and Univar Solutions B.V.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"316"}}