{"id":9362,"date":"2025-12-09T14:58:43","date_gmt":"2025-12-09T11:58:43","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9362"},"modified":"2025-12-09T14:58:43","modified_gmt":"2025-12-09T11:58:43","slug":"proposed-national-system-for-early-identification-and-diagnosis-of-heart-failure-in-jordan","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/proposed-national-system-for-early-identification-and-diagnosis-of-heart-failure-in-jordan\/","title":{"rendered":"Proposed National System for Early Identification and Diagnosis of Heart Failure in Jordan"},"content":{"rendered":"
Proposed National System for Early Identification and Diagnosis of Heart Failure in Jordan<\/div>\n
<\/div>\n
Source: Taskforce Proposal for Implementing National HF Protocols (JCS 2025)<\/div>\n
<\/div>\n
1.\u2060 \u2060Background and Purpose<\/div>\n
<\/div>\n
Early detection of heart failure (HF) in primary care is increasingly important given rising rates of hypertension, diabetes, obesity, and chronic kidney disease.<\/div>\n
The national question was: Is there a simple screening or assessment tool that can be used for early detection of HF in primary care?<\/div>\n
The following summarizes the proposed national approach.<\/div>\n
<\/div>\n
2.\u2060 \u2060Do We Need a Screening Test? What Is Recommended?<\/div>\n
1. Current national and international guidelines do not recommend mass population screening for HF.<\/span><\/div>\n
2. They strongly support targeted early detection among high-risk individuals, using:<\/span><\/div>\n
\u2022 A simple symptom checklist + brief physical exam<\/span><\/div>\n
\u2022 NT-proBNP and ECG when HF is suspected<\/span><\/div>\n
\u2022 Timely referral for echocardiography when uncertainty remains<\/span><\/div>\n
3. This approach is feasible, low-cost, and suitable for primary care, and can reduce complications and repeated hospitalizations when integrated into a clear referral pathway.<\/span><\/div>\n
<\/div>\n
3.\u2060 \u2060Who Is Considered High-Risk? (Simple Rule First, Detailed List Next)<\/div>\n
<\/div>\n
Simple Rule<\/div>\n
\u2022 Older age + hypertension or diabetes or previous heart disease \u2192 treat as high-risk.<\/span><\/div>\n
<\/div>\n
Detailed High-Risk Criteria (1 or more \u2192 high risk)<\/div>\n
1. Hypertension (especially uncontrolled)<\/span><\/div>\n
2. Diabetes mellitus<\/span><\/div>\n
3. Previous heart disease<\/span><\/div>\n
\u2022 Myocardial infarction<\/span><\/div>\n
\u2022 Coronary stent<\/span><\/div>\n
\u2022 Angina<\/span><\/div>\n
4. Atrial fibrillation or irregular pulse<\/span><\/div>\n
5. Chronic kidney disease (CKD)<\/span><\/div>\n
6. Clear obesity or metabolic syndrome<\/span><\/div>\n
7. Age \u2265 60 years<\/span><\/div>\n
<\/div>\n
Any patient with \u2265 2 of these factors \u2192 complete symptom checklist + vital signs + consider NT-proBNP and ECG if symptoms are present.<\/div>\n
<\/div>\n
4.\u2060 \u2060Practical Roles of the Healthcare Workforce (Three-Level Model)<\/div>\n
<\/div>\n
Level 1: Nurse or Community Health Worker (in centers without a doctor)<\/div>\n
<\/div>\n
Primary role: Early suspicion and referral<\/div>\n
1. Identify high-risk patients<\/span><\/div>\n
\u2022 Based on age, hypertension, diabetes, and heart disease history<\/span><\/div>\n
2. Complete the HF Symptom Checklist<\/span><\/div>\n
Ask whether the patient had any of the following in recent weeks:<\/div>\n
\u2022 Dyspnea on exertion<\/span><\/div>\n
\u2022 Orthopnea<\/span><\/div>\n
\u2022 Paroxysmal nocturnal dyspnea<\/span><\/div>\n
\u2022 Leg swelling or unexplained weight gain<\/span><\/div>\n
\u2022 Fatigue or reduced exercise tolerance<\/span><\/div>\n
\u2022 Palpitations<\/span><\/div>\n
\u2022 Nocturnal cough or sudden nighttime dyspnea<\/span><\/div>\n
If \u2265 2 symptoms \u2192 consider HF suspicion<\/div>\n
3. Perform rapid vital-sign assessment<\/span><\/div>\n
\u2022 Blood pressure<\/span><\/div>\n
\u2022 Heart rate<\/span><\/div>\n
\u2022 Weight<\/span><\/div>\n
\u2022 Oxygen saturation (< 90% is concerning)<\/span><\/div>\n
\u2022 Check for lower-limb edema<\/span><\/div>\n
4. Refer suspected cases to the general practitioner<\/span><\/div>\n
\u2022 The nurse does not diagnose \u2013 only identifies and escalates.<\/span><\/div>\n
<\/div>\n
Level 2: General Practitioner \/ Family Physician<\/div>\n
<\/div>\n
Primary role: Confirm suspicion and decide on referral<\/div>\n
1. Review symptoms, vital signs, and risk factors.<\/span><\/div>\n
2. Order ECG + NT-proBNP when suspicion is confirmed.<\/span><\/div>\n
3. Exclude non-cardiac causes of dyspnea:<\/span><\/div>\n
\u2022 COPD<\/span><\/div>\n
\u2022 Anemia<\/span><\/div>\n
\u2022 Obesity<\/span><\/div>\n
\u2022 Thyroid disorders<\/span><\/div>\n
4. Begin basic management of risk factors (hypertension, diabetes, fluid overload).<\/span><\/div>\n
5. Refer to cardiology if:<\/span><\/div>\n
\u2022 NT-proBNP is elevated<\/span><\/div>\n
\u2022 ECG is abnormal<\/span><\/div>\n
\u2022 Symptoms strongly suggest HF<\/span><\/div>\n
6. Some centers may allow the GP to order echocardiography directly.<\/span><\/div>\n
<\/div>\n
The GP\u2019s role is suspicion\u2014not definitive HF diagnosis.<\/div>\n
<\/div>\n
Level 3: Cardiologist (or Internist\/Family Physician where cardiology is unavailable)<\/div>\n
<\/div>\n
Primary role: Definitive diagnosis and management<\/div>\n
1. Confirm HF diagnosis by echocardiography, assessing:<\/span><\/div>\n
\u2022 LVEF<\/span><\/div>\n
\u2022 Cardiac structure and chamber size<\/span><\/div>\n
\u2022 Valves and pericardium<\/span><\/div>\n
2. Classify HF<\/span><\/div>\n
\u2022 HFrEF \u2264 40%<\/span><\/div>\n
\u2022 HFmrEF 41\u201349%<\/span><\/div>\n
\u2022 HFpEF \u2265 50%<\/span><\/div>\n
3. Start or optimize guideline-directed medical therapy (GDMT)<\/span><\/div>\n
\u2022 ARNI \/ ACEI \/ ARB<\/span><\/div>\n
\u2022 Beta-blocker<\/span><\/div>\n
\u2022 MRA<\/span><\/div>\n
\u2022 SGLT2 inhibitor<\/span><\/div>\n
4. Register the patient in the National HF Registry (NHFR-JO)<\/span><\/div>\n
\u2022 Can be done by the cardiologist, nurse, or assistant<\/span><\/div>\n
5. Determine need for advanced therapies<\/span><\/div>\n
\u2022 ICD<\/span><\/div>\n
\u2022 CRT<\/span><\/div>\n
\u2022 LVAD<\/span><\/div>\n
\u2022 Heart transplantation<\/span><\/div>\n
<\/div>\n
5.\u2060 \u2060National Diagnostic Pathway (Summary)<\/div>\n
<\/div>\n
Community \u2192 Primary Care \u2192 HF Center<\/div>\n
<\/div>\n
This pathway reflects the National JCS Heart Failure Protocols (2025), emphasizing:<\/div>\n
\u2022 Early identification<\/span><\/div>\n
\u2022 Structured referral<\/span><\/div>\n
\u2022 Early GDMT initiation<\/span><\/div>\n
\u2022 Integration with the national HF registry<\/span><\/div>\n
\u2022 Clear workforce roles at every level<\/span><\/div>\n
<\/div>\n
This system is practical, scalable, and aligns with Jordan\u2019s primary healthcare capabilities.<\/div>\n
<\/div>\n
6.\u2060 \u2060Diagnostic Criteria for Heart Failure (Simplified)<\/div>\n
<\/div>\n
Heart failure is diagnosed only when all three elements are present:<\/div>\n
1. Symptoms or signs<\/span><\/div>\n
\u2022 Dyspnea, orthopnea, leg swelling, fatigue, nocturnal dyspnea, palpitations<\/span><\/div>\n
2. Abnormal echocardiography<\/span><\/div>\n
\u2022 Reduced LVEF<\/span><\/div>\n
\u2022 Diastolic dysfunction<\/span><\/div>\n
\u2022 Structural heart disease<\/span><\/div>\n
\u2022 Elevated pulmonary pressures<\/span><\/div>\n
3. Elevated NT-proBNP<\/span><\/div>\n
\u2022 \u2265 300 pg\/mL (acute presentations)<\/span><\/div>\n
\u2022 \u2265 125 pg\/mL (chronic cases)<\/span><\/div>\n
\u2022 Very low NT-proBNP effectively excludes HF<\/span><\/div>\n
<\/div>\n
HF is confirmed when:<\/div>\n
Symptoms + Abnormal Echo + Elevated NT-proBNP \u2192 definite diagnosis.<\/div>\n
<\/div>\n
7.\u2060 \u2060Conclusion<\/div>\n
<\/div>\n
The proposed detection system is fully feasible for primary care in Jordan, requiring only basic training for nurses and community health workers.<\/div>\n
Definitive diagnosis and long-term management remain the responsibility of cardiologists or trained physicians.<\/div>\n
<\/div>\n
This structured model ensures early identification, timely treatment, and fewer hospitalizations\u2014supporting national priorities for chronic disease control.<\/div>\n","protected":false},"excerpt":{"rendered":"

Proposed National System for Early Identification and Diagnosis of Heart Failure in Jordan Source: Taskforce Proposal for Implementing National HF Protocols (JCS 2025) 1.\u2060 \u2060Background 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. The national question was: Is […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9362","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9362","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9362"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9362\/revisions"}],"predecessor-version":[{"id":9363,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9362\/revisions\/9363"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9362"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9362"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9362"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}