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Abstract
Measurement of NT-proBNP and copeptin may help identify those at high risk of heart failure (HF). However the value of NT-proBNP and copeptin has been little studied in the older population in primary care. This study aims to examine the use of NT-proBNP and copeptin in improving risk prediction and stratification of HF in older men with and without cardiovascular disease (CVD). This was a prospective study of 3870 men aged 60-79 years with no diagnosed HF followed up for a mean period of 11 years, during which there were 254 incident HF cases. NT-proBNP was associated with HF in those with and without established CVD [diagnosed myocardial infarction (MI), angina, or stroke]. NT-proBNP improved prediction beyond routine conventional risk factors (age, obesity, diabetes, hypertension, history of MI, and history of angina) and the Health ABC Heart Failure Score in all men and in men with and without established CVD (P<0.0001 for improvement in c-statistics). The net reclassification index (NRI) beyond conventional risk factors was 18.8% overall (27.4% for men without CVD and 17.4% for men with CVD). In contrast, copeptin was associated with HF in men with CVD only and did not improve prediction of HF after inclusion of conventional risk factors (P = 0.95 for improvement in c-statistics). NT-proBNP, but not copeptin significantly improves prediction and risk stratification of HF beyond routine clinical parameters obtained in general practice settings in older men both with and without established CVD.
Highlights
Heart failure (HF) constitutes a major and increasing burden of morbidity and mortality in older people, leading to high healthcare costs
Receiver operating characteristic (ROC) curves and areas under the curve (AUC) (c-statistics) were used to assess the ability of NT-proBNP to predict HF beyond a score which included conventional routine risk factors as well as how NT-proBNP predicted beyond the Health ABC Heart Failure Score
We evaluated the ability of NT-proBNP to reclassify risk by calculating the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI).[28]
Summary
Heart failure (HF) constitutes a major and increasing burden of morbidity and mortality in older people, leading to high healthcare costs. Identifying high risk individuals to target HF prevention in primary care remains a priority. Current guidelines have stimulated efforts to focus on identifying those with stage A (presence of risk factors) and stage B HF (asymptomatic ventricular dysfunction detectable on echocardiography), in order to implement early interventions to prevent progression to stage C (overt HF).[1] echocardiography provides effective non-invasive assessment of HF, routine echocardiographic screening is expensive and not currently recommended for use in the general population.[2] The optimal strategy for identifying people at high risk in the general population remains unclear, though the use of blood markers in primary care settings to identify those at high risk of developing HF is potentially.
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