Proposed National System for Early Identification and Diagnosis of Heart Failure in Jordan
Proposed National System for Early Identification and Diagnosis of Heart Failure in Jordan
Source: Taskforce Proposal for Implementing National HF Protocols (JCS 2025)
1. Background and Purpose
Early detection of heart failure (HF) in primary care is increasingly important given rising rates of hypertension, diabetes, obesity, and chronic kidney disease. National and international guidance emphasizes targeted early detection rather than mass screening. The following summarizes the proposed national approach.
2. Screening Strategy and Recommendations
Population-wide screening for HF is not recommended by current guidelines. Targeted early detection among high-risk individuals is strongly supported.
Core tools include symptom checklist, focused examination, NT-proBNP, ECG, and timely echocardiography.
This approach is feasible, low-cost, and suitable for primary care settings.
3. High-Risk Identification
Simple rule: Older age with hypertension, diabetes, or previous heart disease.
Detailed risk factors include hypertension, diabetes, prior myocardial infarction, coronary intervention, atrial fibrillation, chronic kidney disease, obesity, metabolic syndrome, and age ≥60 years.
Patients with two or more risk factors require symptom review and further assessment.
4. Workforce Roles – Three-Level Model
Level 1 (Nurse/Community Health Worker): Identify high-risk patients, assess symptoms, measure vitals, and refer suspected cases.
Level 2 (General Practitioner): Confirm suspicion, order ECG and NT-proBNP, manage risk factors, and refer for echocardiography.
Level 3 (Cardiologist/Trained Physician): Confirm diagnosis, classify HF phenotype, initiate GDMT, register patients, and assess for advanced therapies.
5. National Diagnostic Pathway
Community → Primary Care → HF Center.
Emphasizes early identification, structured referral, GDMT initiation, registry integration, and defined workforce responsibilities.
6. Diagnostic Criteria for Heart Failure
Presence of symptoms or signs of HF.
Abnormal echocardiography findings.
Elevated NT-proBNP (≥300 pg/mL acute; ≥125 pg/mL chronic). HF diagnosis requires all three criteria.
7. Conclusion
This national detection system is practical, scalable, and aligned with Jordan’s healthcare infrastructure. Early identification can be performed in primary care, while definitive diagnosis and long-term management remain with cardiology services. The model supports early treatment, reduces hospitalizations, and strengthens national chronic disease control.
