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 publ...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.展开更多
OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction(LVSD) is more common among clinic patients with rheumatoid disease(RD) compared with the general population, and to assess the d...OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction(LVSD) is more common among clinic patients with rheumatoid disease(RD) compared with the general population, and to assess the diagnostic utility of brain natriuretic peptide(BNP). BACKGROUND:Patients with RD are at increased risk of ischemic heart disease. However, there are few large echocardiographic studies identifying cardiac dysfunction in RD. We hypothesized that LVSD would be more prevalent in RD patients than in the general population. METHODS: A total of 226 hospital out-patients with RD(65% women) underwent clinical evaluation, electrocardiography(ECG), echocardiography, and plasma BNP assay(218 patients). Prevalence of LVSD was compared with local population estimates. RESULTS: Definite LVSD(left ventricular ejection fraction< 40% ) occurred in 5.3% of the RD group: standardized prevalence ratio,3.20; 95% confidence interval, 1.65 to 5.59. Median BNP values were higher in patients with LVSD compared with those without: 16.6 pmol/l versus 8.5 pmol/l, p< 0.005, although values between the two groups overlapped. One in nine patients with an abnormal ECG had definite LVSD. CONCLUSIONS: Definite LVSD was three times more common in RD patients than in the general population. Given the prognostic benefits of treating LVSD, echocardiographic screening of RD patients with an abnormal ECG may be worthwhile.展开更多
文摘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.
文摘OBJECTIVES: This study sought to ascertain whether left ventricular systolic dysfunction(LVSD) is more common among clinic patients with rheumatoid disease(RD) compared with the general population, and to assess the diagnostic utility of brain natriuretic peptide(BNP). BACKGROUND:Patients with RD are at increased risk of ischemic heart disease. However, there are few large echocardiographic studies identifying cardiac dysfunction in RD. We hypothesized that LVSD would be more prevalent in RD patients than in the general population. METHODS: A total of 226 hospital out-patients with RD(65% women) underwent clinical evaluation, electrocardiography(ECG), echocardiography, and plasma BNP assay(218 patients). Prevalence of LVSD was compared with local population estimates. RESULTS: Definite LVSD(left ventricular ejection fraction< 40% ) occurred in 5.3% of the RD group: standardized prevalence ratio,3.20; 95% confidence interval, 1.65 to 5.59. Median BNP values were higher in patients with LVSD compared with those without: 16.6 pmol/l versus 8.5 pmol/l, p< 0.005, although values between the two groups overlapped. One in nine patients with an abnormal ECG had definite LVSD. CONCLUSIONS: Definite LVSD was three times more common in RD patients than in the general population. Given the prognostic benefits of treating LVSD, echocardiographic screening of RD patients with an abnormal ECG may be worthwhile.
