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European Heart Journal Advance Access originally published online on November 2, 2005
European Heart Journal 2006 27(2):193-200; doi:10.1093/eurheartj/ehi559
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?

Gavin I.W. Galasko1, Sophie C. Barnes2, Paul Collinson2, Avijit Lahiri1 and Roxy Senior1,*

1Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, Middlesex, UK
2Department of Chemical Pathology, St George's Hospital, London, UK

Received 7 November 2004; revised 18 June 2005; accepted 8 September 2005; online publish-ahead-of-print 2 November 2005.

* Corresponding author. Tel: +44 20 8869 2547/8; fax: +44 20 8864 0075. E-mail address: roxy.senior{at}virgin.net

Aims To assess the screening characteristics and cost-effectiveness of screening for left ventricular systolic dysfunction (LVSD) in community subjects.

Methods and results A total of 1392 members of the general public and 928 higher risk subjects were randomly selected from seven community practices. Attending subjects underwent an ECG, N-terminal pro-brain natriuretic peptide (NTproBNP) serum levels, and traditional echocardiography (TE). A total of 533 consecutive subjects underwent hand-held echocardiography (HE). The screening characteristics and cost-effectiveness (cost per case of LVSD diagnosed) of eight strategies to predict LVSD (LVSD <45% on TE) were compared. A total of 1205 subjects attended. Ninety six per cent of subjects with LVSD in the general population had identifiable risk factors. All screening strategies gave excellent negative predictive value. Screening high-risk subjects was most cost-effective, screening low-risk subjects least cost-effective. TE screening was the least cost-effective strategy. NTproBNP screening gave similar cost savings to ECG screening; HE screening greater cost-savings, and HE screening following NTproBNP or ECG pre-screening the greatest cost-savings, costing ~650 Euros per case of LVSD diagnosed in high-risk subjects (63% cost-savings vs.TE).

Conclusion Thus several different modalities allow cost-effective community-based screening for LVSD, especially in high-risk subjects. Such programmes would be cost-effective and miss few cases of LVSD in the community.

Key Words: Cost-effectiveness • Left ventricular systolic dysfunction • Screening • Natriuretic peptides • Electrocardiogram • Hand-held echocardiography


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G. Galasko and R. Senior
What is the most useful and cost-effective strategy to screen for left ventricular systolic dysfunction in clinical practice?: reply
Eur. Heart J., June 1, 2006; 27(11): 1383 - 1383.
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Home page
 Eur Heart JHome page
A. Yamada, Y. Yamada, and K. Okada
What is the most useful and cost-effective strategy to screen for left ventricular systolic dysfunction in clinical practice?
Eur. Heart J., June 1, 2006; 27(11): 1382 - 1383.
[Full Text] [PDF]


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