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European Heart Journal Advance Access published online on November 2, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi559
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received November 7, 2004
Revised June 18, 2005
Accepted September 8, 2005

Clinical research

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. Galasko 1, Sophie C. Barnes 2, Paul Collinson 2, Avijit Lahiri 1, and Roxy Senior 1*

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

* To whom correspondence should be addressed.
Roxy Senior, E-mail: roxy.senior{at}virgin.net


  Abstract

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.

Keywords: 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.
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