CLINICAL STUDY: HEART FAILURE
Retrospective analysis of thecost-effectiveness of using plasmabrain natriuretic peptide inscreening for left ventricularsystolic dysfunction in the general population
Olav W. Nielsen, MD, PhD*,*,
Theresa A. McDonagh, BSc, MB, ChB, MD, FRCP ,
Stephen D. Robb, MB, ChB, MD, MRCP and
Henry J. Dargie, MB, ChB, FRCP, FESC
* Cardiology Department, The Western Infirmary, Glasgow and Clinical Research Initiative in Heart Failure, University of Glasgow, Glasgow, United Kingdom
Cardiology Department, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
Manuscript received February 4, 2002;
revised manuscript received September 9, 2002,
accepted September 13, 2002.
* Reprint requests and correspondence: Dr. Olav W. Nielsen, Cardiology Department B, Rigshospitalet, 2200 Copenhagen, Denmark.
own{at}dadlnet.dk
OBJECTIVES: We sought to assess the cost-effectiveness of using plasma brain natriuretic peptide (BNP) as a pre-echocardiographic screening test for left ventricular systolic dysfunction (LVSD) in the general population.
BACKGROUND: We hypothesized that plasma BNP and simple clinical parameters would reduce the number of echocardiograms needed and cost when screening for LVSD in the general population.
METHODS: A random sample of 1,257 community subjects (age 25 to 74 years) was examined. Three risk groups were formed: one group with symptomatic ischemic heart disease (IHD); a second group with blood pressure >160/95 mm Hg and/or an abnormal electrocardiogram (high risk); and a group with none of these risk factors (low risk). The BNP assay was adjusted to give a high sensitivity.
RESULTS: Left ventricular systolic dysfunction was prevalent in 0.7% (6/823), 6% (16/269), and 19% (26/140) of low-risk and high-risk subjects and IHD subjects, respectively. Raised BNP concentrations (>8 pg/ml) occurred in 41%, 64%, and 71%. Sensitivities of BNP for detecting LVSD were 83% (5/6), 94% (15/16), and 92% (24/26); and the negative predictive values were 99.8%, 99.0%, and 95.1%. Brain natriuretic peptide was not associated with LVSD in low-risk subjects (p = 0.087), but in IHD subjects (p = 0.015) and high-risk subjects (p = 0.023). Screening high-risk subjects by BNP before echocardiography could have reduced the cost per detected case of LVSD by 26% for the cost ratio of 1/20 (BNP/echocardiogram).
CONCLUSIONS: Subjects at low and high risk of LVSD can be identified by simple clinical parameters, and BNP testing further reduces the number of echocardiograms needed and the costs of screening in subjects at risk <75 years of age in the general population.
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Abbreviations and Acronyms
| | BNP | | brain natriuretic peptide | | CI | | confidence interval | | ECG | | electrocardiogram or electrocardiographic | | EF | | ejection fraction | | IHD | | ischemic heart disease | | LVSD | | left ventricular systolic dysfunction | | MI | | myocardial infarction | | NNE | | number of subjects needed to be examined by echocardiography to detect one case of LVSD | | OR | | odds ratio | | ROC | | receiver-operating characteristics |
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