Ruling out heart failure in primary-care: the cost-benefit of pre-screening using NT-proBNP and QRS width

International Journal of Cardiology
Kevin M GoodeJ G F Cleland

Abstract

Half of the patients presenting to primary-care with signs and symptoms of heart failure (HF) are found not to have serious heart disease after echocardiographic assessment. This places an unnecessary burden on hospital services. We sought to assess the cost-benefit of screening for left ventricular systolic dysfunction (LVSD) and major structural heart disease (SHD) using N-terminal pro-B-type natriuretic peptide (NT-proBNP) and QRS-width from an electrocardiogram in patients presenting with suspected HF to primary-care physicians (PCP). Patients were recruited from a community-based service pilot. Blood samples for NT-proBNP measurement were obtained in primary-care. All patients were referred irrespective of the NT-proBNP result, with echocardiograms reviewed by a cardiologist blinded to the NT-proBNP result. NT-proBNP<180 pg/ml (21 pmol/l) 'ruled-out' major-LVSD avoiding 38% of echoes and 23% of cost compared with direct referral for echocardiography. NT-proBNP<93 pg/ml (11 pmol/l) 'ruled-out' major-SHD, avoiding 20% of echoes and 8% of cost. A QRS<84 ms 'ruled-out' major-LVSD, avoiding 28% of echoes and 17% of cost. A QRS<82 ms 'ruled-out' major-SHD avoiding 20% of echoes and 9% of cost. Intermediate values of NT-proBNP we...Continue Reading

References

Sep 29, 2001·BMJ : British Medical Journal·L BlueC E Morrison
Mar 26, 2003·Journal of the American College of Cardiology·Allison M PritchettMargaret M Redfield
Jul 2, 2003·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·William A ZoghbiUNKNOWN American Society of Echocardiography
Nov 26, 2003·Clinica Chimica Acta; International Journal of Clinical Chemistry·Kiang-Teck J YeoAnthony W Butch
Feb 28, 2004·European Journal of Heart Failure·John C F Cleland, Kevin Goode
Mar 12, 2004·European Journal of Heart Failure·Lene Svendstrup NielsenHenrik Egeblad
Mar 30, 2005·Archives of Internal Medicine·Markus BattagliaMatthias Egger
May 20, 2005·European Heart Journal·Karl SwedbergUNKNOWN Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology
Jan 16, 2007·European Journal of Heart Failure·Nasrin K KhanUNKNOWN EuroHeart Failure Survey Investigators

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Citations

May 21, 2011·International Journal of Legal Medicine·Sara SabatassoKatarzyna Michaud
May 11, 2016·Expert Review of Pharmacoeconomics & Outcomes Research·Kostas AthanasakisJohn Kyriopoulos
Oct 27, 2018·Open Heart·Alexander T LimkakengL Kristin Newby

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