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Screening for left ventricular systolic dysfunction in high‐risk patients in primary‐care: A cost‐benefit analysis
Author(s) -
Goode Kevin M.,
Clark Andrew L.,
Bristow Janet A.,
Sykes Kim B.,
Cleland John G.F.
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2007.10.003
Subject(s) - medicine , cardiology , qrs complex , logistic regression , receiver operating characteristic , myocardial infarction , univariate analysis , electrocardiography , heart failure , primary care , multivariate analysis , family medicine
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.