Underserved communities at risk of heart failure: effectiveness of community-based recruitment strategies and burden of unrecognised cardiovascular disease.

BACKGROUND

Patients from socioeconomically deprived and ethnically diverse backgrounds are under-represented in cardiovascular research. EARLY-HF is a community-based pilot study designed to predict incident HF in primary care. We aimed to assess effectiveness of recruitment strategies for engaging underserved populations and quantify the burden of unrecognised CVD.

METHODS

Prospective cohort study enrolling 550 adults aged ≥50 years with two or more cardiometabolic risk factors and no prior diagnosis of HF. Participants were recruited via: (i) targeted identification using electronic health records in eight primary care centres; (ii) digital advertising and targeted social media campaign; (iii) ten community outreach events; (iv) direct referral from family or friends. The baseline study visit included ECG, blood sampling, and imaging.

RESULTS

185 (34%) participants were from the most deprived Index of Multiple Deprivation (IMD) quintile and 97 (18%) were of non-White ethnicity. Primary care and digital advertising were the most effective recruitment strategies, enrolling 444 (81%) and 68 (12%) participants respectively, while maintaining diverse representation. The social media campaign generated 15,207 advertisement clicks and 1,012 expressions of interest at a cost of £5.93 per sign-up. Community outreach events enrolled 5 (1%) participants and were resource intensive. A substantial burden of previously unrecognised CVD was identified: 125 (23%) participants had clinically actionable cardiac abnormalities, including 46 (9%) with previously unrecognised myocardial infarction, 331 (60%) had uncontrolled blood pressure (≥140/90 mmHg), and 162 (30%) had elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP ≥125 pg/ml).

CONCLUSIONS

Primary care-embedded and digital recruitment strategies can effectively engage underserved communities at risk of HF, at scale and at low cost. This population has a very high burden of unrecognised CVD.