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

Area of Science:

• Cardiology
• Preventive Medicine
• Biomarker Research

Background:

• Guidelines advocate for biomarker-based screening for pre-heart failure (pre-HF) in at-risk populations.
• Proactive screening is crucial for asymptomatic pre-HF, yet real-world implementation data is limited.
• This study examines a regional pre-HF screening initiative integrated into annual health screenings.

Purpose of the Study:

• To determine the prevalence of elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in a general middle-aged population.
• To identify associated echocardiographic findings in individuals with elevated NT-proBNP.
• To assess adherence throughout the screening-to-consultation pathway for pre-HF.

Main Methods:

• Retrospective analysis of 1585 individuals aged 40-74 undergoing pre-HF screening in Furano City, Japan.
• NT-proBNP testing integrated into annual health screenings; referral for cardiology consultation and echocardiography for levels ≥125 pg/mL.
• Evaluation of NT-proBNP levels, echocardiographic data, and follow-up consultation attendance.

Main Results:

• Near-perfect NT-proBNP testing adherence (99.6%) was observed.
• Elevated NT-proBNP levels (≥125 pg/mL) were found in 7.5% (118/1585) of participants, associated with older age, female sex, and higher blood pressure.
• Only 46.6% (55/118) of those with elevated levels attended cardiology consultations; 40.0% of those evaluated had abnormal echocardiographic findings.

Conclusions:

• Integrating NT-proBNP testing into public health screenings is feasible and achieves high adherence.
• The initiative identified a significant proportion of the middle-aged population with pre-HF indicators, offering prevention opportunities.
• A substantial gap exists in adherence to specialist consultations, necessitating optimization of the post-screening pathway to realize the full benefits of population-wide pre-HF screening.