SCREEN-HF

SCReening Evaluation of the Evolution of New Heart Failure

This prospective, cross-sectional study aims to assess the utility and cost‑effectiveness of NT‑B‑type natriuretic peptide (NTpro‑BNP) in the determination of left ventricular dysfunction in patients at high‑risk for this condition but without known cardiac dysfunction, symptoms of heart failure or previous diagnosis of either condition. NT‑proBNP is a hormone released from the heart in response to pressure or stretch and as such, it is a useful marker of left ventricular dysfunction (LVD), even in the absence of accompanying symptoms. A simple strategy was employed to identify individuals likely to develop chronic heart failure (CHF) focusing on risk factors such as coronary artery disease, valvular heart disease, hypertension and diabetes.

CHF is a major burden on the community due to the poor quality of life and premature death of affected individuals, as well as the costs of care. CHF prevalence is increasing due to the ageing of the population and the improved survival from myocardial infarction (MI) and CHF.  The increasing prevalence of obesity and diabetes, coupled with uncontrolled hypertension, is also likely to accelerate CHF incidence.  Effective therapies for the treatment and prevention of CHF are readily available, and there is great potential to cost-effectively improve the application of these therapies through improved identification of two key patient groups: those with unrecognised CHF, and those at greatly increased risk of CHF due to LVD.  Thus, early detection of disease could lead to more effective use of beneficial therapies, reducing the total burden of symptomatic heart failure and thus the need for high cost devices

44,000 clients of the health insurance company, HBA and members of the general public, aged 60 and over, were invited to participate in the study if they had not been previously diagnosed with heart failure but had one or more risk factors for heart failure (such as a heart attack, stroke, diagnosed hypertension or diabetes).  Approximately 11,000 HBA clients responded to the study invitation and just over 4000 study participants were successfully recruited for the study from mid 2007-09, attending study visits in Melbourne and Shepparton and NT-proBNP, routine bloods and information relating to medical history, concomitant medications, physical and demographic information was collected.  Those with NT-proBNP in the upper quintile (approximately 700 participants) were further assessed for cardiac function via ECG and echocardiographic examination.  The cross‑sectional study was supported by BUPA Australia Group (comprising BUPA Australia Health Pty Ltd and MBF Australia Pty Ltd.).  This cross-sectional study will undergo final analysis in 2010.