Evaluation of Different Strategies for Identifying Asymptomatic Left Ventricular Dysfunction and Pre-Clinical (stage B) Heart Failure in the Elderly. Results from ‘PREDICTOR’, a Population Based-Study in Central Italy

AIMS: To evaluate the accuracy and cost-effectiveness of different screening strategies to identify systolic and/or diastolic asymptomatic LV dysfunction (ALVD), as well as pre-clinical (stage B) heart failure (HF), in a community of elderly subjects in Italy. METHODS AND RESULTS: A sample of 1452 subjects aged 65-84 years were chosen from the original cohort of 2001 randomly selected residents of the Lazio Region (Italy), as a part of the PREDICTOR survey. All subjects underwent physical examination, biochemistry/NT-proBNP assessment, 12-lead ECG, and Doppler transthoracic echocardiography (TE). Five strategies were evaluated including ECG, NT-proBNP, TE, and their combinations. Subjects older than 75 years, and with at least two additional risk factors, were defined as being high-risk for HF (435), whereas the remaining 1017 were defined at low risk. Screening characteristics and cost-effectiveness (cost per case) of the five strategies to predict systolic (EF <50% ) or diastolic ALVD and pre-clinical HF (stage B) were compared. NT-proBNP was the most accurate and cost-effective screening strategy to identify systolic and moderate to severe diastolic LV dysfunction without a difference between the high-risk and low-risk groups. Adding ECG to the NT-proBNP assessment did not improve the detection of pre-clinical LV dysfunction. TE-based screening was the least cost-effective strategy. In fact, all screening strategies were inadequate to identify stage B HF. CONCLUSIONS: In a community of elderly people, NT-proBNP is the most accurate and cost- effective pre-screening strategy to identify systolic and moderate to severe diastolic LV dysfunction.