Biomarker-based pre-heart failure screening in a middle-aged rural population

Guidelines recommend biomarker-based screening for pre-heart failure (pre-HF) among at-risk populations. Although the asymptomatic nature of pre-HF necessitates proactive screening, real-world implementation remains understudied. This retrospective study analyzed data from a regional pre-HF screening initiative, integrated into annual health screenings, to evaluate: (1) the prevalence of elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, (2) associated echocardiographic findings, and (3) adherence across the screening-to-consultation pathway.

This study included individuals aged 40-74 years who received pre-HF screening in Furano City, Japan, from October 2023 to March 2024. During the study period, NT-proBNP testing was incorporated into an existing annual health screening program. Participants with elevated NT-proBNP levels (≥125 pg/mL) were referred for cardiology consultation and echocardiography.

Among 1585 screening attendees (mean age, 54.5 years; females, 57.0 %), 1579 (99.6 %) underwent NT-proBNP testing. Elevated levels were found in 118 (7.5 %) individuals. These individuals were older, female, and had a higher blood pressure. Of these 118 individuals, only 55 (46.6 %) attended the follow-up cardiology consultation. Among those evaluated with echocardiography, 22 (40.0 %) had abnormal findings (increased left atrial volume index and left ventricular end-diastolic volume index being the most common).

Integrating NT-proBNP testing into a public health screening program achieved near-perfect testing adherence. The program identified 7.5 % of the general middle-aged population as having pre-HF with predominantly benign echocardiographic changes, highlighting important prevention opportunities. However, a critical drop-off in adherence to specialist consultation highlights a major implementation gap. Optimizing the post-screening pathway is essential to maximize the potential benefits of population-wide pre-HF screening.