Exploring heart failure prevalence and dimensions: A comprehensive NT-proBNP study in high-risk primary care patients

Early detection of heart failure (HF), particularly in asymptomatic individuals, is essential for timely intervention. This study aimed to determine the prevalence of HF among high-risk individuals in primary care using N-terminal probrain natriuretic peptide (NT-proBNP) screening.

A prospective cohort of 874 participants aged ≥40 years with at least one HF risk factor but no prior HF diagnosis was analysed. NT-proBNP levels were measured, and all participants underwent comprehensive cardiac evaluations, including laboratory tests, electrocardiography and echocardiography.

The mean age of the cohort was 62.5 ± 9.1 years, and 51.9% were female. Based on ACC/AHA HF staging, 69.1% of participants were classified as Stage A, 21.9% as Stage B and 9.0% as Stage C. Elevated NT-proBNP levels were detected in 84.8% of Stage B and 100% of Stage C patients. Among Stage C patients, 92.4% had HF with preserved ejection fraction (HFpEF). NT-proBNP levels correlated positively with left atrial volume index (r = 0.273, P < 0.001), left ventricular mass index (r = 0.207, P < 0.001), E/e' ratio (r = 0.182, P < 0.001) and estimated systolic pulmonary artery pressure (r = 0.124, P < 0.001), while showing a negative correlation with estimated glomerular filtration rate (r = -0.222, P < 0.001).

A significant proportion of high-risk individuals in primary care had undiagnosed HF, particularly Stage B (pre-HF) and early symptomatic Stage C HF. The predominance of HFpEF highlights the need for targeted management. NT-proBNP screening is a valuable tool for early identification and risk stratification, especially for detecting Stage B HF, where it serves as an effective standalone method in the absence of imaging.