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Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial
Mark Ledwidge1, Joseph Gallagher, Carmel Conlon
1Chronic Cardiovascular Disease Management Unit, St Vincent's Healthcare Group/St Michael's Hospital, Dublin, Ireland.
JAMA
|July 4, 2013
Summary
Brain natriuretic peptide (BNP) screening and collaborative care significantly reduced left ventricular dysfunction and heart failure in at-risk individuals. This approach offers a promising strategy for heart failure prevention.
Area of Science:
- Cardiology and Cardiovascular Medicine
- Preventive Cardiology
- Diagnostic Biomarkers in Heart Disease
Background:
- Heart failure prevention strategies are crucial due to its increasing prevalence.
- Early detection of left ventricular (LV) dysfunction is key to preventing heart failure progression.
- Brain natriuretic peptide (BNP) is a recognized biomarker for cardiac strain.
Purpose of the Study:
- To evaluate the effectiveness of a screening program utilizing BNP testing and collaborative care.
- To reduce the incidence of newly diagnosed heart failure and LV systolic/diastolic dysfunction in an at-risk population.
- To assess the impact of this intervention on cardiovascular event hospitalizations.
Main Methods:
- A parallel-group randomized trial (St Vincent's Screening to Prevent Heart Failure Study) involving 1374 participants with cardiovascular risk factors.
- Participants were randomized to usual primary care or screening with BNP testing.
- Intervention group with BNP ≥ 50 pg/mL underwent echocardiography and collaborative specialist care.
Main Results:
- The intervention group showed a significant reduction in the primary endpoint (LV dysfunction with or without heart failure): 5.3% vs 8.7% in the control group (OR, 0.55; P=.003).
- Asymptomatic LV dysfunction was less prevalent in the intervention group (4.3% vs 6.6%; P=.01).
- Emergency hospitalizations for major cardiovascular events were significantly lower in the intervention group (incidence rate ratio, 0.60; P=.002).
Conclusions:
- BNP-based screening combined with collaborative care effectively reduces the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure in at-risk patients.
- This integrated care model demonstrates a significant impact on preventing adverse cardiovascular outcomes.
- The findings support the implementation of BNP screening protocols in primary care for heart failure prevention.
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