Screening

There is no single test for screening the asymptomatic population. Heart failure is a clinical diagnosis and as such could simply rely on a thorough history and careful physical examination of the population to be tested.

B-type natriuretic peptide (BNP) has recently been used as a screening tool for identifying structural heart disease in the general population. In one study, the sensitivity and specificity of BNP testing for identification of structural heart disease were 61% and 92%, respectively.[86] When sex-specific analyses were performed, sensitivity and specificity were 61% and 91% in men, and 50% and 95% in women, respectively. Although the performance of BNP testing on the basis of these figures might seem suboptimal for the population as a whole, efficacy was improved in subgroups with a high prevalence of heart disease, such as the cohort ages 65 years and older, as well as the cohort having cardiovascular risk factors such as hypertension or diabetes. In another trial, blood N-terminal pro-brain natriuretic peptide concentrations were found to play an important role in stratifying older people into left ventricular dysfunction risk groups. The neurohormone was an independent marker for death or admission for heart failure in the medium term.[87] These results suggest that BNP testing for structural heart disease screening in community-based populations might only be useful for cohorts with a high prevalence of heart disease. The American College of Cardiology/American Heart Association/Heart Failure Society guidelines recommend that for patients at risk of developing heart failure (identified by the presence of hypertension, diabetes mellitus, or known vascular disease), natriuretic peptide biomarker-based screening followed by team-based care, including a cardiovascular specialist optimizing guideline-directed management and therapy, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset heart failure. However, further studies are needed to determine cost-effectiveness, its impact on quality of life, and mortality rate.[88]

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