Blood Test Plus Targeted Care May Stop Heart Failure Before It Starts
TUESDAY, March 12 -- A simple blood test conducted annually in your primary care doctor's office might be a first step in preventing heart failure, a new study suggests.
The next steps include getting a diagnostic echocardiogram and then receiving coordinated care between a primary care physician and a cardiologist, according to the Irish pilot study.
The end result: Only about 5 percent of the middle-aged and older patients enrolled in this type of program ended up requiring hospitalization for new-onset heart failure or heart dysfunction, compared with nearly 9 percent of those treated in the usual way.
"With 6 million Americans suffering from heart failure -- most commonly due to heart attacks, chronic hypertension, diabetes or obesity -- this blood test can provide a simple way for us to screen those patients at risk and prevent heart failure from developing," said one expert not connected to the study, Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City.
The findings were presented Monday in San Francisco at the annual meeting of the American College of Cardiology (ACC).
Heart failure is a notoriously tough-to-treat condition in which the heart's pumping action grows gradually weaker over time. "With middle-aged adults having a 20 to 30 percent lifetime risk of developing heart failure, prevention is a critical issue that has not yet been addressed," Steinbaum said.
The new study sought to remedy that situation. Researchers led by Dr. Kenneth McDonald, director of the Heart Failure Unit at St. Vincent's University Hospital in Dublin, focused on a test that measures blood levels of a hormone called B-type natriuretic peptide (BNP), which can be conducted in any primary care office.
Speaking to ACC meeting attendees, McDonald said that numerous studies "indicate that elevated BNP [blood] levels, above and beyond other risk factors, indicate a risk for heart failure."
So, his team used the test as the starting point of a Dublin-area program aimed at spotting people at high risk for heart failure before the condition sets in. The researchers set up a coordinated group of 39 primary care practices that all reported to one cardiac care center in Dublin.
The nearly 1,400 patients included in the study averaged 65 years of age and had no previous symptoms of heart failure. They were randomly separated into two groups: One received usual care, while the other got an annual BNP test. If a patient's blood test showed an elevated BNP level (which occurred in about 42 percent of study participants), they were then sent on to get an echocardiogram and were assigned a cardiologist who worked in partnership with their primary care doctor.
The result: After an average follow-up of more than four years, 42 percent fewer patients in the intervention group went on to be hospitalized with heart failure or heart dysfunction compared to those who received usual care. The need for emergency hospitalizations for cardiac events, such as heart attacks or strokes, also fell by 46 percent, the study found.
The prevention program "targeted four in 10 at-risk patients and reduced the rates of left ventricular dysfunction, heart failure and emergency hospitalizations for major cardiovascular events," McDonald said.
One reason the program worked so well may be that patients worked harder to stay healthy once they learned of their elevated risk. "It was explained to patients that [high BNP] was an indicator of heart vessel damage and, undoubtedly, I would think this improved adherence to therapy," McDonald explained.
Steinbaum applauded the effort. "In using this simple blood test, those patients who were determined to be at risk were more aggressively followed," she said. "Heart failure is often the end point of heart disease, and its critical nature leads to a major drain on the health care system through multiple hospitalizations. If these patients could be detected prior to getting sick, the potential of saving lives and saving money is tremendous."
Another expert agreed.
"One of the biggest problems we see in medicine is identifying patients who will develop disease, instead of just treating diseases when they occur," said Dr. Lawrence Phillips, assistant professor in the department of medicine at NYU Langone Medical Center, in New York City.
"Although patients will become symptomatic when they develop active heart failure, more of our time should be spent trying to stop patients from developing and progressing to heart failure," Phillips said.
Research presented at medical meetings is typically considered preliminary until published in a peer-reviewed journal.
To find out more about heart failure, head to the American Heart Association.
Posted: March 2013
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