title: 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.
abstract: OBJECTIVE
  Rescreen a large community cohort to examine the progression to heart failure over time and the role of natriuretic peptide testing in screening.
  
  
  METHODS
  Observational longitudinal cohort study.
  
  
  METHODS
  16 socioeconomically diverse practices in central England.
  
  
  METHODS
  Participants from the original Echocardiographic Heart of England Screening (ECHOES) study were invited to attend for rescreening.
  
  
  METHODS
  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.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Taylor
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Roalfe
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Lynda
authors.initials: L
authors.lastname: Tait
authors.affiliation: Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Davis
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Iles
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Marites
authors.initials: M
authors.lastname: Derit
authors.affiliation: Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D004739:England; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D014463:Ultrasonography
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: EPIDEMIOLOGY