A one-stop “hub” for CV screening and treatment that leverages the reputation of local football clubs, common across the United Kingdom, is a promising form of outreach to communities, a new report shows.

Through point-of-care and artificial intelligence (AI)-enabled tools, healthcare professionals at the clinic identified previously undiagnosed heart failure (HF) and respiratory disease. A research letter outlining the program and its impact was published online this week in JACC: Heart Failure.

Rajiv Sankaranarayanan, MBBS, PhD (Liverpool University Hospitals NHS Foundation Trust, England), and colleagues developed the BEAT Breathlessness Community Hub through Everton in the Community (EitC), an official charity of Everton Football Club.

The idea, they write, was to “harness the brand of football” as a means of engaging the community, providing targeted early detection, and getting patients started on the right guideline-directed medical therapy just after diagnosis. Importantly, they selected a region where socioeconomic barriers prevent many from seeking timely care for HF symptoms.

Speaking with TCTMD, Sankaranarayanan pointed out that HF affects 1 million people in the UK. “The issue with this condition is the vast majority of people”—around 80%—“are diagnosed when they’re acutely unwell and present to hospital via the emergency department,” he said. “So we wanted to shift that to an earlier diagnosis in the community, whereby we can pick up the problems when people are . . . at an earlier stage of the disease trajectory but also start them on lifesaving treatment earlier.”

This approach, he added, also relieves pressure on the healthcare system, since people diagnosed with HF in an emergency hospitalization, on average, stay in the hospital 9 or 10 days.

“In the UK, football is a great medium of speaking to people,” Sankaranarayanan said. “Football clubs tend to have a mass following and appeal, and people are very, very loyal to the football club. . . . So we thought: let’s harness that power and utilize it for healthcare.”

Over the years, multiple initiatives worldwide have attempted to meet patients where they’re at, so to speak, whether that’s barbershops, churches, or elsewhere in the community.

What’s unique here is that the screening is so comprehensive and is followed by timely treatment, said Sankaranarayanan. “It’s an algorithm we adopted called BEAT to Treat, where we can bring everything together within 60 minutes.”

BEAT Breathlessness

BEAT Breathlessness, which received funding from AstraZeneca, recruited participants ages 40 and older via invitations sent by primary care teams, social media, and communications from the EitC and Liverpool City Council. Additionally, an EitC health awareness coordinator reached out to local communities by attending local programs and events.

The hub’s team included a consultant cardiologist, specialist HF and respiratory nurses, a psychologist, smoking-cessation counselors, and volunteers from the Pumping Marvellous Foundation, a UK-based group for HF patients.

Screening for HF consisted of BEAT-HF questions covering breathlessness, exhaustion, and ankle swelling. Individuals who reported symptoms underwent NT-proBNP testing. The visit also included assessment of blood pressure, heart rate, and volume status, as well as auscultation and a 30-second 6-lead ECG (Kardia).

People with elevated NT-proBNP levels then underwent clinical exams and AI-interpreted echocardiography (Kosmos; EchoNous plus Us2.ai) performed by a heart failure specialist nurse or general practitioner, with the results vetted by a cardiologist. They also were referred for standard echocardiography at a later date.

Additionally, AI-enabled spirometry was performed for people with risk factors like smoking or occupational exposure who also had respiratory symptoms.

‘The Brand of Football’

In all, 1,112 people (mean age 60.9 years; 45% women; 11.2% racial/ethnic minorities) attended the hub between May and October 2024.

One in 10 had a prior diagnosis of diabetes. Three in 10 had a prior diagnosis of hypertension, and 32% had elevated blood pressure at the time of screening (of whom 57% did not have known hypertension).

On-site testing showed that 23% had hyperglycemia and 2.1% had atrial fibrillation. Among the 25% of individuals who underwent NT-proBNP testing on the basis of HF symptoms, 16% (n =  44) had a biomarker level exceeding 400 ng/L and 21% (n = 56) had a level between 125 and 400 ng/L.

This resonates with quite a lot of people irrespective of where they’re based and which healthcare system, whether it’s in the US, Europe, or otherwise. Rajiv Sankaranarayanan

Heart failure was then confirmed through AI-enabled echocardiography and specialist review in 33 people—3% of all attendees and 75% of those with high NT-proBNP. Ejection fraction was reduced in 40%, preserved in 54%, and mildly reduced in 6%. Multivariate predictors of new HF diagnosis included older age, hypertension, and various HF symptoms.

Six of the 33 people were then onboarded to an acute HF virtual ward for home and ambulatory IV diuretics plus guideline-directed medical therapy, to be followed by standard echocardiography. One received emergency pacemaker implantation.

Additionally, 12% of attendees were found to have chronic obstructive pulmonary disease, while 30% had both that condition and HF.

Sankaranarayanan said that most patients diagnosed with HF followed through on receiving further care.  “It might be the appeal of things being initiated under the auspices of the football club,” he suggested. “So that there is that trust element.”

A key ingredient to their success, he added, is that patients provided input “right from the outset, and even currently in terms of evaluating the program, seeing that it’s working well.”

On the heels of this positive experience, the BEAT Breathlessness team is looking to expand their concept in other regions through sporting or entertainment events. Already, others in France and Spain have started to leverage football clubs for similar outreach, Sankaranarayanan reported. “This resonates with quite a lot of people irrespective of where they’re based and which healthcare system, whether it’s in the US, Europe, or otherwise.”