CORSscore: Decision support system for the novel Cardiac Output Response to Stress(CORS) test SCORE for risk stratification and early diagnosis of heart failure

This project will develop the CORS test SCORE for early diagnosis of Heart Failure (HF), allowing more effective interventions in a recognised area of unmet clinical need. HF is a complex clinical syndrome characterised by reduced heart function (cardiac output) at rest and/or during exertion. Early diagnosis is essential to facilitate use of evidence-based treatment known to reduce morbidity/mortality and repeated hospitalisations.

Early diagnosis is challenging as HF is not easily discriminated between conditions such as obesity and lung disease. Approximately 65% referrals proved to be inaccurate, costing the NHS up to £42M pa. GPs in primary care play a key role in early diagnosis, but are impeded by limited diagnostic tools and lack of access to haemodynamic measures.

Our previous work has established the feasibility of the Cardiac Output Response to Stress (CORS) test. This uses validated bioreactance technology over three measurement phases (rest-supine, challenge-standing and stress-step exercise), and may readily be integrated into the clinical care pathway. Feasibility is confirmed with 91% suspected HF patients able to complete all phases. Preliminary analysis reveals that CORS test data, when combined with four other clinical variables (i.e. CORS test SCORE) predicts HF with an accuracy (specificity) of 89%, significantly higher than the 65% from NTproBNP alone.

CORS is not intended to replace existing methods, but is complementary to them. For example, serum natriuretic peptides (NTproBNP) are useful to 'rule out' HF but reduced specificity (65%) results in a high number of false positives leading to inappropriate referrals to secondary care. CORS is easy to administer and non-invasive, and could be implemented widely in primary and community health care settings.

Project under review (Baxter Int, USA)

Total project value: $275,683