Observational longitudinal cohort study to determine progression to heart failure in a screened community population : the Echocardiographic Heart of England Screening Extension (ECHOES-X) study

Research output: Contribution to journalArticle

Authors

  • Lynda Tait
  • Russell C. Davis
  • F. D Richard Hobbs

External organisations

  • OXFORD UNIVERSITY
  • Primary Care Clinical Sciences; University of Birmingham; Edgbaston Birmingham UK
  • Department of Primary Health Care Health Sciences, University of Oxford, Oxford, UK.
  • Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust

Abstract

Objectives: Rescreen a large community cohort to examine the progression to heart failure over time and the role of natriuretic peptide testing in screening. Design: Observational longitudinal cohort study. Setting: 16 socioeconomically diverse practices in central England. Participants: Participants from the original Echocardiographic Heart of England Screening (ECHOES) study were invited to attend for rescreening. Outcome measures: Prevalence of heart failure at rescreening overall and for each original ECHOES subgroup. Test performance of N Terminal pro-B-type Natriuretic Peptide (NT-proBNP) levels at different thresholds for screening. Results: 1618 of 3408 participants underwent screening which represented 47% of survivors and 26% of the original ECHOES cohort. A total of 176 (11%, 95% CI 9.4% to 12.5%) participants were classified as having heart failure at rescreening; 103 had heart failure with reduced ejection fraction (HFREF) and 73 had heart failure with preserved ejection fraction (HFPEF). Sixty-eight out of 1232 (5.5%, 95% CI 4.3% to 6.9%) participants who were recruited from the general population over the age of 45 and did not have heart failure in the original study, had heart failure on rescreening. An NT-proBNP cut-off of 400 pg/mL had sensitivity for a diagnosis of heart failure of 79.5% (95% CI 72.4% to 85.5%) and specificity of 87% (95% CI 85.1% to 88.8%). Conclusions: Rescreening identified new cases of HFREF and HFPEF. Progression to heart failure poses a significant threat over time. The natriuretic peptide cut-off level for ruling out heart failure must be low enough to ensure cases are not missed at screening.

Details

Original languageEnglish
Article numbere005256
JournalBMJ open
Volume4
Issue number7
Publication statusPublished - 11 Jul 2014

Keywords

  • Epidemiology

ASJC Scopus subject areas