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Using a simple blood test to identify patients at risk for heart failure is cost effective

Heart failure (HF) is a major problem in the United States, with 550,000 new cases each year. Survival is very poor, with only 20 percent of men age 65 and older surviving to 5 years after development of symptoms. According to a recent study, a simple blood test is a cost-effective way to identify patients who are at risk of HF due to reduced left ventricular ejection fraction before they develop HF symptoms. The study was conducted by the Southern California Evidence-based Practice Center, which is supported by the Agency for Healthcare Research and Quality (contract 290-97-0001).

The left ventricle is the heart's pumping chamber. It contracts and ejects 60 percent of blood into the aorta with each contraction (a ventricular ejection fraction of 60 percent).

The research team led by Paul A. Heidenreich, M.D., M.S., used a decision model to estimate economic and health outcomes for different screening strategies using a $30 B-type natriuretic peptide (BNP) blood test (BNP is released primarily by cardiac ventricles in response to abnormal loading conditions) and echocardiography (sonogram of the heart) to detect left ventricular ejection fraction (EF) less than 40 percent (weak ability to pump blood) for men and women aged 60 years.

The researchers calculated that screening 1,000 asymptomatic patients with BNP followed by echocardiography in those with an abnormal BNP test increased the lifetime cost of care ($176,000 for men, $101,000 for women) but improved patient outcomes (7.9 quality-adjusted life years (QALYs) for men and 1.3 for women), resulting in a cost per QALY of $22,300 for men and $77,700 for women. Screening populations in which at least 1 percent have depressed EF with BNP followed by echocardiography cost less than $50,000 per QALY gained. This cost is comparable to or less than other accepted health interventions.

See "Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction," by Dr. Heidenreich, Matthew A. Gubens, M.S., Gregg C. Fonarow, M.D., and others, in the March 17, 2004, Journal of the American College of Cardiology 43, pp. 1019-1026.

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