Closing the Gap Before the First Hospitalization

Heart failure is the most expensive, and most preventable, catastrophic event in chronic disease care. The physiologic signals that precede a hospitalization — rising filling pressure, early fluid retention — are measurable noninvasively, months before a patient feels anything. Standard care usually doesn't go looking for them until the patient is already symptomatic.

That's a staging problem, not a knowledge problem. The 2022 AHA/ACC/HFSA heart failure guideline explicitly named two pre-symptomatic stages — Stage A (at risk) and Stage B (structural or biomarker evidence, no symptoms yet) — and said prevention should target them directly. Most care models still don't reach a patient until Stage C, once symptoms are already present.

What the evidence shows

Two recent studies give physicians a way to act on that guidance. A 2025 study in JACC Advances screened 2,040 primary care patients with diabetes, chronic kidney disease, or clinical suspicion of heart failure, using a noninvasive brachial cuff and single-lead ECG to estimate left ventricular end-diastolic pressure (LVEDP). Elevated pressure showed up in 38.5% of them. Nearly a third of those patients — 31.4% — had no symptoms at all: Stage B disease, caught before it became Stage C.

The second study, presented at the American College of Cardiology's 2026 scientific session, followed 150 patients with HFpEF for a median of 38.4 months, half monitored at home with a lung-impedance device and half on standard care. The monitored group went a median of 602 days before their first heart failure hospitalization — the standard-care group averaged 83. Recurrent hospitalizations dropped 81% (74% for first-event), and all-cause mortality by 60%. The mechanism wasn't a new drug; physicians in the monitored group simply adjusted medication more than twice as often, and did it earlier — while congestion was still preclinical, when the response to treatment is strongest.

How SYNC-PREVENT™ puts this to work

SYNC-PREVENT™ turns that evidence into a four-step pathway, each step triggered automatically by the last so the most intensive monitoring reaches only the patients who need it. Interoperability data — hospital admissions, lab results, active prescriptions, specialist notes — flags patients matching the same eligibility criteria used in the JACC Advances study. Biomarker testing adds cardiometabolic context. A brief in-office LVEDP screen confirms elevated filling pressure. Patients who screen positive move into continuous at-home monitoring, where a physician sees fluid trends building days to weeks before a patient would notice anything themselves.

“Heart failure does not begin in the emergency department. It begins silently, years before the first hospitalization. The protocol that catches it must begin there, too.”

Modeled conservatively across a 1,000-patient panel — applying the published screening rate and a deliberately conservative version of the published hospitalization reduction — the pathway prevents an estimated 19 to 30 hospitalizations a year, avoiding $542,000 to $970,000 in cost. The physician makes every medication decision; the monitoring just means they're making it weeks earlier, with a patient who's still at home.