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European Journal of Heart Failure 2007 9(12):1186-1195; doi:10.1016/j.ejheart.2007.10.003
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© 2007 European Society of Cardiology

Screening for left ventricular systolic dysfunction in high-risk patients in primary-care: A cost-benefit analysis

Kevin M. Goode*, Andrew L. Clark, Janet A. Bristow{maltese cross}, Kim B. Sykes and John G.F. Cleland

Department of Cardiology, Castle Hill Hospital Kingston-upon-Hull, United Kingdom

* Corresponding author. Department of Cardiology 3rd Floor Haughton Building, Hull Royal Infirmary, Anlaby Road, Kingston-upon-Hull, HU3 2JZ, United Kingdom. Tel.: +44 1482 675006; fax: +44 1482 675922. kevin.goode{at}hey.nhs.uk (K.M. Goode).


  Abstract

Background: Appropriate screening strategies are needed to cost effectively identify patients with undiagnosed and untreated left ventricular systolic dysfunction (LVSD).

Aim: To investigate the cost-benefit of screening high-risk patients in primary-care for LVSD (EF<40%) using various screening strategies.

Methods: Patients considered at high-risk of developing LVSD were recruited from three primary-care practices. Patients with known LVSD were excluded. Echocardiography, electrocardiography and blood tests were performed blinded to an NT-proBNP result. Logistic regression (LR) and receiver-operating characteristic analysis were used to assess the univariate and multivariable utility of NT-proBNP, QRS duration, symptoms and evidence of myocardial infarction (MI) to detect LVSD.

Results: 427 patients were assessed. 7.5% had undiagnosed LVSD. NT-proBNP, QRS, symptoms and MI were independent predictors of LVSD (p<0.014) and the resultant LR-model had an area-under-the-curve of 0.89 (0.84–0.94) and specificity of 54% (51–79%) at a sensitivity of 100%. The LR-model avoided 24.1% (18.1– 48.3%) of the cost and 50.1% (44.1–74.3%) of the echocardiograms compared to screening using echocardiography alone.

Conclusions: Screening high-risk groups in primary-care increases the pick-up rate for undiagnosed LVSD and using an LR-model combining NT-proBNP, QRS, symptoms and evidence of MI has significant cost benefits.

Key Words: Screening • Primary-care • Left ventricular systolic dysfunction • Natriuretic peptides • Electrocardiogram • Cost-benefit analysis

Received March 9, 2007; Revised September 24, 2007; Accepted October 11, 2007

{maltese cross} This paper is dedicated to the memory of Janet Bristow who sadly died in 2006.


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