The increasing prevalence of heart failure emphasises the need for effective prevention strategies; brain-type natriuretic peptide (BNP) has been found to identify those at highest risk of cardiovascular events and heart failure. Therefore the purpose of this study was to determine whether using BNP and collaborative care could reduced newly diagnosed heart failure cases and the prevalence of significant left ventricular systolic and/or diastolic dysfunction (LV).
This was a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors recruited from 39 primary care practices in Ireland. Mean follow-up was for 4.2 years. Patients were randomly assigned to receive usual primary care (control; n=677) or screening with BNP testing (n=697). In the intervention group, a finding of BNP level 50pg/mL or higher led to the patient undergoing echocardiography and collaborative care between their primary care physician and specialist cardiovascular service. The main outcome measure was the prevalence of asymptomatic ventricular dysfunction with or without newly diagnosed heart failure.
263 patients (41.6%) in the intervention group had at least one BNP reading of 50pg/mL or greater. The intervention group underwent more cardiovascular investigations (P<.001) and received more renin-angiotensin-aldosterone-based therapy at follow up (56.5% vs. 49.6% for the control group; P=.01). Left ventricular dysfunction with or without heart failure (the primary endpoint) was seen in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio 0.55; P=.003). Asymptomatic LV dysfunction was found in 6.6% of the control group patients, compared to 4.3% of the intervention group (P=.01). Lower rates of emergency hospitalisations for major cardiovascular events were also seen in the intervention group (P=.002).
BNP based screening of patients at risk for heart failure, in conjunction with collaborative care, reduced rates of left ventricular systolic dysfunction, diastolic dysfunction, and heart failure.
- Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic Peptide–Based Screening and Collaborative Care for Heart Failure. JAMA 2013;310:66-74.