NT-proBNP Testing Research Articles

Guideline-Directed Medical Therapy Use in the STRONG-HF Trial.

Assessment of medication changes in heart failure trials and registries is complex and may not capture the entirety of care. A comprehensive and standardized method is needed. We used different methods to assess the use of guideline-directed medical therapies (GDMT) and verified the association between GDMT intensity score with the STRONG-HF trial (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing of Heart Failure Therapies) clinical outcomes. We used data from the STRONG-HF trial to examine the baseline GDMT use for all randomized patients by applying the GDMT intensity score and evaluated its change over time. We also examined their basic adherence, indication-corrected adherence, and dose-corrected adherence, and the association with clinical outcomes up to 180 days. At 90 days, triple therapy indication-corrected use increased from 4.5% to 36% in the usual care group, and from 5.2% to 93.5% in the high-intensity care group (P<0.001 between the 2 groups). Triple therapy dose-corrected use increased from 4.5% to 20.5% in the usual care group, and from 3.3% to 77.4% in the high-intensity care group (P<0.001). The GDMT intensity score at baseline was <6 in 358 (33%) patients, 6 to 7 in 329 (31%) patients, and >7 in 386 (36%) patients. At 90 days, 88.4% of patients in the high-intensity arm achieved a score >7 versus 14.3% in the usual care arm (P<0.0001). The GDMT intensity score was correlated with clinical outcomes at 180 days. The GDMT intensity score provides a comprehensive description of medication use by means of standardized measurements and is linked to clinical outcomes. Future studies should consider utilizing this as a trial end point. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03412201.

Ergospirometry for preoperative risk assessment in patients with colorectal cancer

Functional status is one of the key points for preoperative risk assessment in major surgery. Objective measures such as DASI questionnaires, NT-proBNP testing and cardiopulmonary exercise testing became more popular for analysis of functional capabilities instead of subjective assessment due to its low sensitivity. This review is devoted to the role of ergospirometry in patient functional status assessment and its prognostic value before colorectal cancer surgery. Searching for literature data was performed in the PubMed, Clinical Trials, Google Scholar, eLibrary, CyberLeninka databases between 2000 and 2024. We found 423 articles and enrolled 46 ones. There were 6 randomized clinical trials, 19 retrospective clinical trials, 6 population-based studies, 2 meta-analyses, 4 systematic reviews and 8 non-systematic reviews.

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Value of non-invasive remote monitoring in managing weight, symptoms, and reducing hospitalizations in heart failure patients : An analysis of a French cohort over one year

Changes in Liver Function Tests, Congestion, and Prognosis After AcuteHeartFailure: The STRONG-HF Trial.

Changes in Liver Function Tests, Congestion, and Prognosis After AcuteHeartFailure: The STRONG-HF Trial.

PRIMARY-HF: Heart Failure Screening in Primary Care using Point-of-Care.

Heart failure is a major health challenge with high morbidity and socioeconomic burden, especially when diagnosis is delayed. In primary care, HF detection can be challenging due to symptoms overlapping with other conditions, limited access to diagnostic tools, and resource constraints. This study explores the use of natriuretic peptides (NT-proBNP) and point-of-care ultrasound (POCUS) with artificial intelligence integration as tools to improve HF screening and management in primary care. This study aims to determine whether NT-proBNP testing alone or combined with cardiac POCUS improves heart failure diagnosis and management in primary care settings, and to evaluate the cost-effectiveness of this approach. This randomized controlled trial will involve patients aged 50 or older with suspected HF or cardiovascular risk factors, recruited across four primary care centers. Participants will be randomly assigned to one of four groups: standard of care (SoC), SoC with NT-proBNP, SoC with NT-proBNP and POCUS, and SoC with POCUS. Primary outcomes include new HF diagnosis, initiation of guideline-directed medical therapy, and improvement in health-related quality of life. Secondary outcomes include cost-effectiveness and the quality assessment of POCUS performed by trained primary care physicians. The integration of NT-proBNP and POCUS in primary care may enhance early heart failure diagnosis, optimize therapy, improve patient quality of life, and reduce healthcare costs associated with heart failure misdiagnosis and delayed treatment. This study could support the broader adoption of accessible diagnostic tools to improve heart failure management in primary care.

Studies of NT-proBNP testing in the emergency department and evaluation of point of care testing for NT-proBNP using the LumiraDx instrument

Introduction: The primary aim of this study was to compare the accuracy of a point-of-care instrument for analysis of NT-proBNP (NT-proBNPLumiraDx) versus conventional plasma NT-proBNP results (NT-proBNPRoche). Secondary aims were: (i) to extract all plasma NT-proBNP results from this emergency department (ED) for the year 2022 and to characterize this patient cohort; (ii) to distinguish the coefficient of variation (CV) for NT-proBNP when analyzed with NT-proBNPLumiraDx. Methods: In 142 patients NT-proBNPLumiraDx determinations were compared to NT-proBNPRoche. In 2022, a total of 8,333 NT-proBNP results were reported to the ED. These samples were routine requests for NT-proBNP from the ED at Uppsala University Hospital, Uppsala, Sweden. NT-proBNP was analyzed with the LumiraDx instrument in samples from 133 healthy blood donors, to calculate reference intervals. Results: There was a significant Spearman rank correlation between age and NT-proBNPRoche analytes (P&lt;0.0001). The median age of the patients was 76 years [interquartile range: (IQR) 65-84 years] and median NT-proBNP value was 576 ng/L (IQR: 138-2,390). In 3,612 out of 8,333 NT-proBNP test results were 400 ng/L or lower. The median CV for the NT-proBNPLumiraDx was 2.2% (range 0.1-5.2%). Conclusion: There was a strong Deming correlation between the two NT-proBNP methods: NT-proBNPLumiraDx = 1.025x NT-proBNPRoche + 9.51; r = 0.982). NT-proBNP is an important analyte for the emergency department. The strong correlation between the two NT-proBNP assays indicates that the NT-proBNPLumiraDx could be used in the emergency department for point-of-care testing. This finding strongly supports the clinical importance of our findings.

Increased myocardial stiffness as assessed by echocardiographic shear wave imaging is associated with Fontan circulatory failure

Abstract Background Diastolic dysfunction with elevated end-diastolic pressures is a key component of Fontan circulatory failure. However, conventional echocardiographic parameters of diastolic function do not correlate with invasive pressures in Fontan patients. Natural shear waves (SW) are emerging as a novel echocardiographic parameter of myocardial stiffness, a key determinant of diastolic function. Purpose We investigated the relationship between natural SW velocities and Fontan circulatory failure. Methods Fontan patients were prospectively recruited from a single center. They underwent a blood sampling for NT-proBNP and cardiopulmonary exercise testing on a supine bicycle combined with echocardiography and with peripheral venous pressure (PVP) measurement. PVP correlates with mean pulmonary arterial pressure in Fontan patients, and a PVP/cardiac output (CO) slope &amp;gt; 3 is associated with worse clinical status. In addition, high frame rate SW imaging was performed at rest in the parasternal long axis view. An anatomic M-mode was drawn along the ventricular septum, or if absent, in the corresponding anterior wall. In the color-coded M-mode maps for tissue acceleration, SW appear as tilted green bands after atrio-ventricular valve closure (AVVC), the slope of which represents their propagation velocity. A clinical diagnosis of Fontan circulatory failure was defined as one the following: dyspnea on exertion with NT-proBNP &amp;gt;300 ng/l, need for diuretics, a peak oxygen consumption (VO2) inferior to the lowest quartile according to age- and sex-adjusted Fontan norms, Fontan associated liver disease complicated by ascites or hepatocellular carcinoma, or protein losing enteropathy. Results Twenty-nine Fontan patients were included, of which 48.3% were female and 82.76% had a dominant left ventricle. The mean age was 33.7 ±8.6 years, the mean peak VO2 19.9 ± 5.9 ml/min/kg and the median NT-proBNP 225 ng/l (IQR 52-473.5). SW velocities increased with age (r = 0.63, p &amp;lt; 0.001) and time since Fontan palliation (r = 0.53, p = 0.005, Figure 1A). In addition, SW velocities significantly correlated with unfavorable clinical parameters: lower peak VO2 (r = -0.76, p &amp;lt; 0.001), elevated NT-proBNP (r = 0.53, p = 0.003) and an increased PVP/CO slope (r = 0.66, p &amp;lt; 0.001) (Figure 1 B-D). Of interest, SW velocities were significantly higher in patients with a clinical diagnosis of Fontan circulatory failure (mean 5.3 vs 7.4 m/sec, p = 0.003, Figure 2A). A cut-off value of 6.3 m/sec had a 90% sensitivity and 84% specificity to predict Fontan circulatory failure (AUC = 0.89; 95% CI [0.77 – 0.99], p = 0.001, Figure 2B). Conclusion Natural SW velocities after AVVC strongly correlated with parameters of Fontan circulatory failure. The preliminary results of this ongoing study highlight the potential of SW elastography in the assessment of patients with a Fontan circulation. Figure 1 Figure 2

Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation

Rapid Uptitration of Guideline-Directed Medical Therapies in Acute Heart Failure With and Without Atrial Fibrillation

Obstetric anesthesia management of dilated cardiomyopathies and heart failure: a narrative review

Obstetric anesthesia management of dilated cardiomyopathies and heart failure: a narrative review

Association Between Late Gadolinium Enhancement with or Without Reverse Remodeling and Prognosis

Late gadolinium enhancement (LGE) in cardiovascular magnetic resonance imaging (CMR) prevents left ventricular reverse remodeling (LVRR), resulting in a poor prognosis. However, the prognosis of patients who have LGE and achieve LVRR and patients who do not have LGE and do not achieve LVRR remains unknown. This study aimed to answer this question by sorting patients with heart failure based on the presence of LGE and LVRR and comparing their prognoses. Another aim was to identify useful factors for predicting LVRR.All patients were followed-up for 24 months. LVRR was defined as a ≥ 10% increase at the last follow-up at 12 ± 6 months from baseline, on echocardiography. The primary endpoint was a composite of cardiovascular death and hospitalization due to worsening heart failure within 18 ± 6 months. Baseline data and data from each outpatient visit were collected and analyzed. We enrolled 80 consecutive patients with heart failure and reduced left ventricular ejection fraction (< 50%) who underwent CMR.LGE was positive in 40 patients (50.0%) and LVRR was observed in 50 patients (63%). The incidence of the primary endpoint was significantly lower in the group that achieved LVRR, regardless of LGE status (LGE-positive group, P = 0.01; LGE-negative group, P = 0.02). In the multivariate analysis, the percentage change in NT-pro BNP levels at 3 months, NT-pro BNP levels at 6 months, and age were independent predictors of LVRR.LGE-positive patients may have a better prognosis if they achieve LVRR. Serial NT-pro BNP testing may be a valuable predictor of LVRR.

Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk

Titration of Medications After Acute Heart Failure Is Safe, Tolerated, and Effective Regardless of Risk

Predictors of clinical outcome in adults with repaired tetralogy of Fallot and the prognostic value of surrogate markers of right ventricular dyssynchrony

Abstract Introduction Sequelae or residual lesions after surgical repair of tetralogy of Fallot (rTOF) are inevitable and have an impact on long-term outcome. So far, most of our attention was directed to negative consequences of residual pulmonary regurgitation. Less attention has been paid to the impact of right bundle branch block and intraventricular dyssynchrony on biventricular function, exercise capacity and clinical outcome. Purpose Using the Swiss Adult Congenital HEart disease Registry we aimed to investigate the 5-year clinical course of adults with rTOF late after surgical repair. We used echocardiography strain analysis as surrogate to quantify right and left ventricular dyssynchrony and correlated our findings with routine clinical measures from cardiopulmonary exercise testing, neurohumoral blood work and cardiac magnetic resonance imaging with the aim to identify patients at increased risk for an adverse clinical event. Methods 2D speckle-tracking strain analysis of the right and left ventricle was performed with dedicated software (Tomtec, Germany). RV dyssynchrony index was measured as the standard deviation of time to peak shortening (TTP) in six RV segments. Interventricular shortening delay (IVSD) was defined as the maximal delay of TTP between ventricular segments. We constructed a multivariate model with NT-proBNP, ECG, clinical, imaging and exercise testing variables to predict the composite outcome of all-cause mortality, relevant arrhythmias and hospital admission for decompensated heart failure. Results A total of 285 patients were included. During a mean follow-up of 48±21 months, 33 patient (12 %) suffered an adverse event with a mean time to event of 30 ± 21 months after the baseline visit. RV dyssynchrony index and IVSD did not differ statistically between the groups with and without events (49±31ms vs 41±18ms, p-value 0.21, 130±65ms vs. 103±50ms, p-value 0.9). In the multivariate Cox-regression model, NT-proBNP, right atrial area and peak heart rate at exercise testing were independent predictors of outcome. An integrated risk score with the median values of these 3 variables as cut-off was highly accurate in separating patients at low risk (score 0; n=39) and high risk (score 3; n=38) for an adverse event. After 6 years of follow-up, no patient at low risk (score 0) had an adverse event, while in 62% of patients at high risk (score 3) an adverse event occurred (p&amp;lt;0.001). Conclusion In our cohort of rTOF patients, echocardiographic surrogates of RV dyssynchrony did not correlate with clinical events. An integrated multimodality approach proved to be effective in predicting outcomes.

Safety Indicators in Patients Receiving High-intensity Care After Hospital Admission for Acute Heart Failure: The STRONG-HF Trial

BackgroundSafety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-proBNP Testing, of Heart Failure Therapies (STRONG-HF) demonstrated the safety and efficacy of rapid up-titration of guideline-directed medical therapy (GDMT) with high-intensity care (HIC) compared with usual care in patients hospitalized for acute heart failure (HF). In the HIC group, the following safety indicators were used to guide up-titration: estimated glomerular filtration rate of <30 mL/min/1.73 m2, serum potassium of >5.0 mmol/L, systolic blood pressure (SBP) of <95 mmHg, heart rate of <55 bpm, and N-terminal pro-B-type natriuretic peptide concentration of >10% higher than predischarge values. Methods and ResultsWe examined the impact of protocol-specified safety indicators on achieved dose of GDMT and clinical outcomes. Three hundred thirteen of the 542 patients in the HIC arm (57.7%) met ≥1 safety indicator at any follow-up visit 1–6 weeks after discharge. As compared with those without, patients meeting ≥1 safety indicator had more severe HF symptoms, lower SBP, and higher heart rate at baseline and achieved a lower average percentage of GDMT optimal doses (mean difference vs the HIC arm patients not reaching any safety indicator, –11.0% [95% confidence interval [CI] –13.6 to –8.4%], P < .001). The primary end point of 180-day all-cause death or HF readmission occurred in 15.0% of patients with any safety indicator vs 14.2% of those without (adjusted hazard ratio 0.84, 95% CI 0.48–1.46, P = .540). None of each of the safety indicators, considered alone, was significantly associated with the primary end point, but an SBP of <95 mm Hg was associated with a trend toward increased 180-day all-cause mortality (adjusted hazard ratio 2.68, 95% CI 0.94–7.64, P = .065) and estimated glomerular filtration rate decreased to <30 mL/min/1.73 m2 with more HF readmissions (adjusted hazard ratio 3.60, 95% CI 1.22–10.60, P = .0203). The occurrence of a safety indicator was associated with a smaller 90-day improvement in the EURO-QoL 5-Dimension visual analog scale (adjusted mean difference –3.32 points, 95% CI –5.97 to –0.66, P = .015). ConclusionsAmong patients with acute HF enrolled in STRONG-HF in the HIC arm, the occurrence of any safety indicator was associated with the administration of slightly lower GDMT doses and less improvement in quality of life, but with no significant increase in the primary outcome of 180-day HF readmission or death when appropriately addressed according to the study protocol.

Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria

Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria

Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction

Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction

Prognostic Impact of Global Longitudinal Strain and NT-proBNP on Early Development of Cardiotoxicity in Breast Cancer Patients Treated with Anthracycline-Based Chemotherapy

Background. The most important anthracycline side effect is cardiotoxicity, resulting in congestive heart failure (HF). Early detection of cardiac dysfunction and appropriate treatment can improve outcomes and reduce the progression of HF. The aim of our study was to evaluate changes in clinical data, echocardiographic parameters, and NT-proBNP, as well as their associations with early anthracycline-induced cardiotoxicity (AIC) in patients treated with anthracycline-based chemotherapy. Methods and Materials. Patients with breast cancer were prospectively assessed with echocardiography, as well as NT-proBNP testing at baseline, (T0), after two cycles (T1) and four cycles (T2) of chemotherapy. AIC was defined as a new decrease in the LVEF of 10 percentage points, to a value below the lower limit of normal. Results. We evaluated 85 patients aged 54.5 ± 9.3 years. After a cumulative dose of 237.9 mg/m2 of doxorubicin, 22 patients (25.9%) met the criteria of AIC after chemotherapy. Patients who subsequently progressed to cardiotoxicity had demonstrated a significantly larger impairment in LV systolic function compared to those who did not develop cardiotoxicity (LVEF: 54.0 ± 1.6% vs. 57.1 ± 1.4% at T1, p < 0.001, and 49.9 ± 2.1% vs. 55.8 ± 1.6% at T2, p < 0.001; GLS: −17.8 ± 0.4% vs. −19.3 ± 0.9% at T1, p < 0.001, and −16.5 ± 11.1% vs. −18.5 ± 0.9% at T2, p < 0.001, respectively). The levels of NT-proBNP increased significantly from 94.8 ± 43.8 ng/L to 154.1 ± 75.6 ng/L, p < 0.001. A relative decrease in GLS ≤ −18.0% (sensitivity: 72.73%; specificity: 92.06%; AUC, 0.94; p < 0.001) and a relative increase in NT-proBNP > 125 ng/L (sensitivity: 90.0%; specificity: 56.9%; AUC, 0.78; p < 0.001) from baseline to T1 predicted subsequent LV cardiotoxicity at T2. Conclusions. Decrease in GLS and elevation in NT-proBNP were significantly associated with AIC, and these could potentially be used to predict subsequent declines in LVEF with anthracycline-based chemotherapy.

Brain natriuretic peptide and N-terminal brain natriuretic peptide for the diagnosis of haemodynamically significant patent ductus arteriosus in preterm neonates.

Brain natriuretic peptide and N-terminal brain natriuretic peptide for the diagnosis of haemodynamically significant patent ductus arteriosus in preterm neonates.

Receiver Operating Characteristics of NT-Probnp in the Transfusion Associated Dyspnea: Prospective Observation & Laboratory Assessment (TADPOL) Study of Cardiorespiratory Versus Febrile Presentation Archetypes

Receiver Operating Characteristics of NT-Probnp in the Transfusion Associated Dyspnea: Prospective Observation & Laboratory Assessment (TADPOL) Study of Cardiorespiratory Versus Febrile Presentation Archetypes

Point-of-care NT-proBNP for the screening of PREGnancy-related Heart Failure – the PREG-HF study

Abstract Introduction Cardiovascular disease is an important cause of maternal mortality worldwide. However, diagnosing heart failure (HF) during pregnancy remains challenging. Patients with HF present with symptoms that are often attributed to the physiological changes of pregnancy. Although the measurement of natriuretic peptides (such as NT-proBNP) has been recommended as a cost-effective screening test for HF, its value in predicting underlying structural heart disease on echocardiography during pregnancy is unclear. Purpose To evaluate the accuracy of point-of-care (POC) NT-proBNP to predict echocardiographic evidence of structural heart disease in pregnant women. Methods All consecutive consenting pregnant women with symptoms of HF (New York Heart Association functional class [NYHA FC] II–IV), who underwent echocardiography at Groote Schuur Hospital (a tertiary hospital in South Africa) between 1 March 2021 and 15 March 2022 were recruited and compared with asymptomatic pregnant women (NYHA FC I). Demographic and obstetric data were collected, as well as clinical and echocardiographic parameters. POC NT-proBNP was measured; a receiver operating characteristic (ROC) curve was used to determine the level of NT-proBNP that would have the best predictive value for detecting structural heart disease on echocardiography. Results We included 121 women with a median age of 31.3 years (IQR 24.9–36.4) and a median gravidity of 3 (2–4), mostly in their third trimester of pregnancy (75.2%). Symptomatic women (66.1%) presented mainly with dyspnoea (92.5%) and fatigue (73.8%). Most common signs of HF were peripheral oedema (46.8%), jugular venous distension (17.7%) and pulmonary crackles (17.7%). Overall, the median POC NT-proBNP was 98pg/ml (60–506) but was not statistically different between symptomatic and asymptomatic participants. However, NT-proBNP levels were significantly elevated in those with left ventricular (LV) dilatation (376 [86–744] vs 65 [60–191], p=0.001), left atrial enlargement (395 [65–744] vs 60 [59–108], p&amp;lt;0.001), LV systolic dysfunction (510 [113–1668] vs 65 [60–210], p&amp;lt;0.001), diastolic dysfunction (300 [77–1450] vs 78 [60–257], p=0.031), mitral regurgitation (167 [60–672] vs 78 [60–243], p=0.038) and pericardial effusion (440 [81–1031] vs 71 [60–243], p=0.011) (Figure 1). An NT-proBNP of &amp;lt;200pg/ml had the highest negative predictive value (83%) to rule out structural heart disease (AUC 0.68 [0.59–0.77]). Patients with NT-proBNP of ≥200pg/ml were at increased risk of having echocardiographic evidence of structural heart disease (diagnostic odds ratio 4.9 [95% confidence interval 2.0–11.7]). Conclusion In this cohort of pregnant women with symptoms suggestive of HF, POC NT-proBNP identified those with structural heart disease with acceptable discrimination. POC NT-proBNP testing might be particularly useful as a screening test in settings where pregnant women do not readily have access to echocardiography. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): World Heart Federation Salim Yusuf Emerging Leaders Programme

Primary care screening and prevention of heart failure coordinated by cardiologist in rural areas

Abstract Purpose Current guidelines do not support community-wide screening for undetected asymptomatic left ventricular systolic dysfunction (LVSD), reduced (HFrEF), mid-range (HFmrEF) or preserved (HFpEF) heart failure (HF), either with natriuretic peptides (NTproBNP) or open access echocardiography (echo). Universal access to NTproBNP testing (with reimbursement in primary care) before referral for tissue doppler and speckle-tracking echo may be needed to facilitate HF diagnosis at earlier, more treatable stage. Methods 4376 consecutive patients (pts) were referred from January 2015 by general practitioners (GP) to echolab with suspected HF symptoms (unexplained breathlessness or ankle swelling). After confirmation elevated NTproBNP (&amp;gt;400 pg/mL) and MESA (Multi-Ethnic Study of Atherosclerosis) 5-year HF risk score ≥10 points and after exclusion significant valvular disease and abnormal electrocardiogram or chest x-ray in subgroup of randomly selected 829 asymptomatic elderly (≥65 years) pts (age 71±4 years, 48% women) with continued usual care by GP was compared with randomly selected 833 asymptomatic elderly pts from 5 GP practices in rural areas with prospective follow-up by regional cardiologist. Results At referral in both groups were similar baseline characteristics, 14% pts were treated with ACE-inhibitor (ACEi), 5% beta-blockers (BB) and 39% loop-diuretics. After cardiologist consultation loop-diuretics withdrawn in 90% pts, ACEi and BB use increased significantly to 98% and 82% in both groups (all p&amp;lt;0.001). Global LVSD (EF≤50%) was detected in 5% at baseline and 23% pts after 5 years in GP group, respectively 5.4% at baseline and 7% after 5 years in cardiologist group (p&amp;lt;0.001). Systolic dysfunction (S'≤6.0 cm/s) occurred in 14% at baseline and 38% pts after 5 years in GP group, respectively 15% at baseline and 21% after 5 years in cardiologist group (all p&amp;lt;0.001). Reduced global longitudinal (GLS&amp;lt;16%) observed in 20% at baseline and 51% pts after 5 years in GP group, respectively 21% at baseline and 29% after 5 years in cardiologist group (all p&amp;lt;0.001). At baseline we found 0.5% pts with new-onset HF in both groups (only HFmrEF). After mean follow-up of 54±4 months in cardiologist group developed new HF in 3% pts (1% HFmrEF, 2% HFpEF) compared with 19% pts (3% HFrEF, 7% HFmrEF, 9% HFpEF) in GP group (p&amp;lt;0.001). Significant (p&amp;lt;0.001) predictors of incident HFmrEF were systolic dysfunction (S'≤6.0 cm/s), hazard ratio (HR) 2.2, 95% CI 1.82–2.9) and reduced GLS (HR 3.5, 95% CI 3.1–3.9), all p&amp;lt;0.01. The strongest (p&amp;lt;0.001) predictors of incident HFpEF were new-onset atrial fibrillation (HR 1.9, 95% CI 0.9–3.9) and echo-detected left ventricular hypertrophy (septal and posterior wall thickness ≥13 mm, HR 1.52, 95% CI 1.22–1.89), all p&amp;lt;0.01. Conclusions For preventing HF progression is required additional research focused on cooperative care between GP and specialised HF outpatient clinic. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grant from the Slovak Society of Cardiology 2015 Selective screening of heart failure stages in regional settings