Proactive heart failure screening in obesity: design, recruitment, and baseline characteristics of the SCORHFE trial

Abstract

Abstract Background Obesity is strongly associated with heart failure (HF), but recognition remains challenging in primary care because symptoms, physical findings, and natriuretic peptide concentrations may be difficult to interpret. Objectives To describe the design, recruitment, baseline characteristics, and acceptability of a trial evaluating proactive multimodal HF screening in adults with obesity. Methods Adults aged 45 years or older with obesity and no known cardiac disease were randomized 1:1 to proactive multimodal HF screening or usual care. Screening comprised medical history, physical examination, blood sampling, 12-lead electrocardiography, and transthoracic echocardiography. The primary endpoint is left ventricular dysfunction and/or acute HF hospitalization at 1 year. Results Between March 2024 and June 2025, 746 individuals expressed interest, 629 (84.3%) underwent eligibility assessment, and 420 were randomized. Mean age was 58.3 ± 8.4 years, 295 participants (70.2%) were women, and median body mass index was 35.0 [32.4–38.0] kg/m2. Among 385 participants with available waist circumference data, 379 (98.4%) had central obesity. Ninety-seven participants (23.1%) had two or more cardiometabolic conditions. Among a random subset of 50 screened participants, 46 (92.0%) considered screening duration acceptable, 47 (94.0%) reported low procedural burden, and 46 (92.0%) supported routine implementation. Conclusions Recruitment through primary care obesity pathways reached adults with substantial adiposity and cardiometabolic burden. Screening acceptability was high in a random subset. One-year follow-up will determine clinical and economic effects. Trial registration number NCT06137261.