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Screening for Heart Failure in Patients with Hypertension And/Or Diabetes Using Hand-Held Echocardiography: A Pilot
Zi-Xuan Yang1, Yu Kang2, Xue-Ke Zhong3
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
Hand-held echocardiography (HHE) screening effectively identifies early-stage heart failure (HF) in high-risk patients with hypertension and/or diabetes. A combined strategy using symptoms, NT-proBNP, and HHE is feasible, cost-effective, and accurate for community primary care.
Area of Science:
- Cardiology
- Primary Care Medicine
- Medical Technology
Background:
- Hypertension and diabetes are significant risk factors for heart failure (HF).
- Early detection of HF, particularly Stages B and C, is crucial for timely intervention and improved patient outcomes.
- Community-based screening programs can enhance access to cardiovascular care for at-risk populations.
Purpose of the Study:
- To evaluate the feasibility and cost-effectiveness of hand-held echocardiography (HHE) for screening Stage B or C heart failure.
- To assess the diagnostic accuracy of a stepwise screening strategy combining symptoms, NT-proBNP, and HHE.
- To promote early diagnosis and intensified care for individuals with hypertension and/or diabetes in community health settings.
Main Methods:
- Recruitment of patients with hypertension and/or diabetes without prior HF diagnosis from two community health centers.
- Stratification of patients into HF Stages A, B, and C using symptom assessment, NT-proBNP levels (cut-off ≥ 125 pg/ml), and HHE findings.
- Comparison of diagnostic accuracy and cost-effectiveness of various pre-specified screening strategies.
Main Results:
- Out of 423 participants, 67.0% showed HHE abnormalities, most commonly interventricular septum thickening (47.0%).
- Left ventricular systolic dysfunction was found in 4.3% of patients.
- A stepwise strategy using symptoms, NT-proBNP, and HHE achieved 100% accuracy and reduced costs by 31.3%, reclassifying 56.7% as Stage B and 13.9% as Stage C HF.
Conclusions:
- HHE-based screening effectively identifies numerous cases of Stage B and mild Stage C HF in high-risk populations.
- A stepwise screening approach integrating symptoms, NT-proBNP, and HHE is feasible and cost-effective.
- This integrated screening strategy should be implemented in community-based primary care settings for early HF detection.
Objective:
This study aimed to assess the feasibility and cost-effectiveness of hand-held echocardiography-based screening for Stage B or C heart failure among individuals with hypertension and/or diabetes at the High-tech Area Fangcao Community Health Service Center and the Tianfu New Area Huayang Community Health Service Center in Chengdu, China, with the objective of promoting early diagnosis and intensified care.
Methods:
Patients with hypertension and/or diabetes registered and cared for at two community health service centers (CHSCs; Chengdu, China) with no history of clinical heart failure were recruited between October 2021 and December 2021. By combining symptom assessment (dyspnea and/or edema) and N-terminal-probrain natriuretic peptide (NT-proBNP ≥ 125 pg/ml as the cut-off) levels with HHE for any indexed abnormality in the dedicated semi-quantitative protocol, patients were categorized into heart failure (HF) Stages A, B, and C. The diagnostic accuracy and cost-effectiveness of several pre-specified screening strategies were compared.
Results:
Of the 423 patients (70 ± 9 years; males, 46.6%) enrolled, 166 (39.2%) were symptomatic and 106 (25.1%) exhibited elevated NT-proBNP levels. Hand-held echocardiography (HHE) abnormalities were detected in 286 (67.0%) patients, with interventricular septum thickening (47.0%) being the most common finding, followed by left atrial enlargement (30.0%). Left ventricular systolic dysfunction was identified in 18 (4.3%) patients. A total of 240 (56.7%) patients were reclassified as HF Stage B and 59 (13.9%) as Stage C. The stepwise strategy of using symptoms for initial stratification, followed by the selection of HHE or NT-proBNP in different circumstances, resulted in 100% accuracy and a 31.3% reduction in costs.
Conclusions:
HHE-based focused HF screening allows for the early identification of numerous cases of Stage B and mild Stage C HF in high-risk populations. A stepwise screening strategy incorporating symptoms, NT-proBNP, and HHE is feasible and cost-effective and should be adopted in community-based primary care settings.
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