Primary care signals and diagnostic pathways before incident heart failure: a systematic scoping review
Author(s)
Type
Journal Article
Abstract
Introduction: Heart failure may be preceded by non-specific symptoms or indicators recorded in primary care, although these records do not necessarily represent heart failure or missed diagnosis. We mapped quantitative evidence on prediagnostic signals, investigation, referral, diagnosis setting and outcomes.
Methods: We conducted a systematic scoping review of quantitative observational studies of incident or newly diagnosed adult heart failure that included a primary care, community or ambulatory first-contact component. Databases were searched from January 2000 to 1 May 2026. Two reviewers independently screened records, extracted data and assessed risk of bias using Joanna Briggs Institute tools. Heterogeneous findings were synthesised narratively and organised by dataset family.
Results: Eleven reports were included as sources of evidence. Most were UK retrospective linked-record cohorts; six reports used overlapping national English data, and five used independent datasets from Portugal, other UK regions and the USA. Recorded symptoms or indicators before diagnosis occurred in 30.0% to 66.5% of patients. In the largest contemporary English cohort, 12.5% underwent natriuretic peptide testing, 19.8% echocardiography and 34.4% specialist referral. Hospital or acute-care diagnosis was common and was associated with poorer mortality, admission or cost outcomes. Repeat consultations and clinicians’ responses to recurrence were rarely measured directly.
Conclusion: The evidence describes recorded prediagnostic intervals and pathway gaps, not proven missed or avoidable diagnostic delay. It does not establish repeated or unresolved presentation as a clinical trigger. Primary studies should define recurrence, determine whether earlier records plausibly reflected heart failure, and adjudicate whether repeated presentation identifies preventable diagnostic opportunities.
Methods: We conducted a systematic scoping review of quantitative observational studies of incident or newly diagnosed adult heart failure that included a primary care, community or ambulatory first-contact component. Databases were searched from January 2000 to 1 May 2026. Two reviewers independently screened records, extracted data and assessed risk of bias using Joanna Briggs Institute tools. Heterogeneous findings were synthesised narratively and organised by dataset family.
Results: Eleven reports were included as sources of evidence. Most were UK retrospective linked-record cohorts; six reports used overlapping national English data, and five used independent datasets from Portugal, other UK regions and the USA. Recorded symptoms or indicators before diagnosis occurred in 30.0% to 66.5% of patients. In the largest contemporary English cohort, 12.5% underwent natriuretic peptide testing, 19.8% echocardiography and 34.4% specialist referral. Hospital or acute-care diagnosis was common and was associated with poorer mortality, admission or cost outcomes. Repeat consultations and clinicians’ responses to recurrence were rarely measured directly.
Conclusion: The evidence describes recorded prediagnostic intervals and pathway gaps, not proven missed or avoidable diagnostic delay. It does not establish repeated or unresolved presentation as a clinical trigger. Primary studies should define recurrence, determine whether earlier records plausibly reflected heart failure, and adjudicate whether repeated presentation identifies preventable diagnostic opportunities.
Date Issued
2026-12-01
Date Acceptance
2026-09-02
Citation
Journal of Primary Care & Community Health, 2026, 17, pp.1-15
ISSN
2150-1319
Publisher
SAGE Publishing
Start Page
1
End Page
15
Journal / Book Title
Journal of Primary Care & Community Health
Volume
17
Copyright Statement
© The Author(s) 2026. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https:// creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us. sagepub.com/en-us/nam/open-ac
License URL
Identifier
10.1177/21501319261488368
Subjects
heart failure
primary care
diagnosis
diagnostic pathways
scoping review
electronic health records
Publication Status
Published
Date Publish Online
2026-09-09