title: Screening for left ventricular systolic dysfunction in high-risk patients in primary-care: a cost-benefit analysis.
abstract: BACKGROUND
  Appropriate screening strategies are needed to cost effectively identify patients with undiagnosed and untreated left ventricular systolic dysfunction (LVSD).
  
  
  OBJECTIVE
  To investigate the cost-benefit of screening high-risk patients in primary-care for LVSD (EF<40%) using various screening strategies.
  
  
  METHODS
  Patients considered at high-risk of developing LVSD were recruited from three primary-care practices. Patients with known LVSD were excluded. Echocardiography, electrocardiography and blood tests were performed blinded to an NT-proBNP result. Logistic regression (LR) and receiver-operating characteristic analysis were used to assess the univariate and multivariable utility of NT-proBNP, QRS duration, symptoms and evidence of myocardial infarction (MI) to detect LVSD.
  
  
  RESULTS
  427 patients were assessed. 7.5% had undiagnosed LVSD. NT-proBNP, QRS, symptoms and MI were independent predictors of LVSD (p<0.014) and the resultant LR-model had an area-under-the-curve of 0.89 (0.84-0.94) and specificity of 54% (51-79%) at a sensitivity of 100%. The LR-model avoided 24.1% (18.1- 48.3%) of the cost and 50.1% (44.1-74.3%) of the echocardiograms compared to screening using echocardiography alone.
  
  
  CONCLUSIONS
  Screening high-risk groups in primary-care increases the pick-up rate for undiagnosed LVSD and using an LR-model combining NT-proBNP, QRS, symptoms and evidence of MI has significant cost benefits.
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull, UK. kevin.goode@hey.nhs.uk
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Goode
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: Janet A
authors.initials: JA
authors.lastname: Bristow
authors.forename: Kim B
authors.initials: KB
authors.lastname: Sykes
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D009200:Myocardial Contraction / Q000502:physiology*; D011320:Primary Health Care / Q000191:economics*; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology