Table 1
Definition of HF stages.
| SYMPTOM | HHE | NT-proBNP | HF STAGES | SUBGROUPS |
|---|---|---|---|---|
| – | – | – | SAHF | A1 |
| + | – | – | SAHF | A2 |
| – | – | + | SBHF | B1 |
| – | + | – | SBHF | B2 |
| – | + | + | SBHF | B3 |
| + | + | – | SBHF | B4 |
| + | – | + | SCHF | C1 |
| + | + | + | SCHF | C2 |
[i] HF, heart failure; HHE, hand-held echocardiography; NT-proBNP, N-terminal pro-brain natriuretic peptide.
Figure 1
The scheme of HF stage screening strategies. HHE, hand-held echocardiography; NT-proBNP, N-terminal-probrain natriuretic peptide; SAHF, stage A heart failure; SBHF, stage B heart failure; SCHF, stage C heart failure. *If not performed/tested.
Figure 2
The distribution of HF stages and their subtypes. HHE, hand-held echocardiography; NT-proBNP, N-terminal-probrain natriuretic peptide; SAHF, stage A heart failure; SBHF, stage B heart failure; SCHF, stage C heart failure.
Table 2
Comparisons among HF stages.
| SAHF (n = 124) | SBHF (n = 240) | SCHF (n = 59) | P VALUE | |
|---|---|---|---|---|
| Age, years | 65.7 ± 9.9 | 70.2 ± 7.5* | 76.1 ± 5.8*# | <0.001 |
| Males, n (%) | 46 (37.1) | 122 (50.8)* | 29 (49.2) | 0.041 |
| BMI, kg/m2 | 24.8 ± 3.2 | 25.3 ± 3.2 | 25.2 ± 3.6 | 0.353 |
| SBP, mmHg | 130.8 ± 17.1 | 137.4 ± 15.0* | 134.4 ± 15.0 | 0.001 |
| DBP, mmHg | 76.4 ± 9.4 | 78.3 ± 10.0 | 74.8 ± 10.2# | 0.030 |
| HR, beats/min | 75.5 ± 13.6 | 74.2 ± 14.3 | 73.2 ± 9.9 | 0.554 |
| Hypertension, n (%) | 93 (75.0) | 210 (87.5)* | 55 (93.2)* | 0.001 |
| Diabetes, n (%) | 70 (56.5) | 112 (46.7) | 37 (62.7)# | 0.040 |
| AF, n (%) | 1 (0.8) | 7 (2.9) | 8 (13.6)*# | 0.001 |
| CAD, n (%) | 12 (9.2) | 26 (10.8) | 17 (28.8)*# | 0.001 |
| CKD, n (%) | 0 (0.0) | 1 (0.4) | 2 (3.4) | 0.073 |
| COPD, n (%) | 5 (4.0) | 5 (2.1) | 2 (3.4) | 0.556 |
| NT-proBNP, pg/ml | 46.4 (28.7, 83.7) | 58.7 (33.2, 103.5) | 267.0 (175.8, 484.9)*# | <0.001 |
| LVEDD, mm | 42.5 ± 3.8 | 43.0 ± 5.3 | 43.9 ± 4.8 | 0.188 |
| LA-ap, mm | 29.2 ± 3.5 | 32.7 ± 5.4* | 33.6 ± 6.7* | <0.001 |
| IVS, mm | 9.8 ± 1.0 | 12.2 ± 2.2* | 12.4 ± 2.5* | <0.001 |
| LVEF, % | 67.4 ± 8.8 | 68.6 ± 10.1 | 67.6 ± 10.6 | 0.489 |
[i] AF, atrial fibrillation; BMI, body mass index; CAD, coronary artery disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DBP, diastolic blood pressure; HHE, hand-held echocardiography; HR, heart rate; IVS, interventricular septum; LA, left atrium; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-brain natriuretic peptide; SAHF, stage A heart failure; SBHF, stage B heart failure; SBP, systolic blood pressure; SCHF, stage C heart failure. *p < 0.05, compared with SAHF group; #p < 0.05, compared with SBHF group.
Table 3
Diagnostic accuracy and cost-effectiveness of screening strategies.
| SINGLE TEST | COMBINED TESTS | STEPWISE TESTS | GOLD STANDARD TESTS | ||||
|---|---|---|---|---|---|---|---|
| STRATEGY I–1 | STRATEGY I–2 | STRATEGY I–3 | STRATEGY II–1 | STRATEGY II–2 | STRATEGY III | ||
| TP, n | 128 | 106 | 282 | 175 | 291 | 299 | 299 |
| FP/error diagnosis, n | 38 | 0 | 0 | 38 | 38 | 0 | 0 |
| TN, n | 86 | 124 | 124 | 86 | 86 | 124 | 124 |
| FN/missed diagnosis, n | 171 | 193 | 17 | 124 | 8 | 0 | 0 |
| Sensitivity (95% CI), % | 42.8 (37.2, 48.6) | 35.5 (30.1, 41.2) | 94.3 (91.1, 96.7) | 58.5 (52.7, 64.2) | 97.3 (94.8, 98.8) | 100 | / |
| Specificity (95% CI), % | 69.4 (60.3, 77.1) | 100 | 100 | 69.4 (60.4, 77.3) | 69.4 (60.4, 77.3) | 100 | / |
| NPV (95% CI), % | 33.5 (27.8, 39.6) | 39.1 (33.7, 44.7) | 87.9 (81.1, 92.8) | 41.0 (34.2, 47.9) | 91.5 (83.9, 96.3) | 100 | / |
| PPV (95% CI), % | 77.1 (69.8, 83.1) | 100 | 100 | 82.2 (76.4, 87.1) | 88.5 (84.5, 91.7) | 100 | / |
| Accuracy (95% CI), % | 50.6 (45.7, 55.5) | 54.4 (49.5, 59.2) | 96.0 (93.6, 97.6) | 61.7 (56.9, 66.4) | 89.1 (85.8, 91.9) | 100 | / |
| Symptom cost*, ¥ | 4,230.0 | 0 | 0 | 4,230.0 | 4,230.0 | 4,230.0 | 4,230.0 |
| NT-proBNP cost*, ¥ | 0 | 42,300.0 | 0 | 42,300.0 | 0 | 20,400.0 | 42,300.0 |
| HHE cost*, ¥ | 0 | 0 | 42,300.0 | 0 | 42,300.0 | 36,400.0 | 42,300.0 |
| Total cost, ¥ | 4,230.0 | 42,300.0 | 42,300.0 | 46,530.0 | 46,530.0 | 61,030.0 | 88,830.0 |
| Cost per TP case, ¥ | 33.0 | 399.1 | 150.0 | 265.9 | 159.9 | 204.1 | 297.1 |
| Cost reduction#, % | 88.9 | 34.3 | 50.5 | 10.5 | 46.2 | 31.3 | / |
[i] FN, false negative; FP, false positive; NPV, negative predictive value; NT-proBNP, N-terminal pro-brain natriuretic peptide; PPV, positive predictive value; TN, true negative; TP, true positive; * manifested as the number of cases tested multiplied by the unit cost; #cost reduction = [1– (cost per TP case of each strategy/cost per TP case of gold standard)] × 100%.