Screening for left ventricular systolic dysfunction in high-risk patients in primary-care: a cost-benefit analysis

Area of Science:

• Cardiology
• Primary Care Medicine
• Diagnostic Strategy Evaluation

Background:

• Cost-effective identification of undiagnosed left ventricular systolic dysfunction (LVSD) is crucial.
• Screening strategies are needed to detect LVSD in high-risk populations.
• Early detection of LVSD improves patient outcomes.

Purpose of the Study:

• To evaluate the cost-benefit of screening high-risk primary care patients for LVSD (ejection fraction <40%).
• To compare various screening strategies for LVSD detection.
• To assess the utility of NT-proBNP, QRS duration, symptoms, and myocardial infarction (MI) evidence.

Main Methods:

• Recruitment of high-risk patients from primary care practices, excluding those with known LVSD.
• Performance of echocardiography, electrocardiography, and blood tests, blinded to NT-proBNP results.
• Application of logistic regression (LR) and receiver-operating characteristic analysis to assess predictors of LVSD.

Main Results:

• 7.5% of assessed patients had undiagnosed LVSD.
• NT-proBNP, QRS duration, symptoms, and MI were independent predictors of LVSD (p<0.014).
• The LR model demonstrated high accuracy (AUC 0.89) and reduced costs by 24.1% and echocardiograms by 50.1% compared to echocardiography alone.

Conclusions:

• Screening high-risk groups in primary care significantly increases the detection rate of undiagnosed LVSD.
• An LR model integrating NT-proBNP, QRS duration, symptoms, and MI evidence provides substantial cost benefits.
• This combined approach enhances diagnostic efficiency and cost-effectiveness in primary care settings.