Evaluation of a combined symptom-based questionnaire and capillary natriuretic peptides testing for early detection of heart failure: a heart failure awareness days nationwide screening study (DEPIC FR)
Résumé
Abstract Aims Early diagnosis of heart failure (HF) remains challenging, as symptoms are often nonspecific or absent. We aimed to evaluate the performance of a two-step screening strategy combining a symptom-based questionnaire—based on the acronym EPOF (dyspnoea, weight gain, oedema, fatigue in french)—and capillary NT-proBNP fingerstick testing to identify individuals with elevated cardiovascular risk or preclinical HF. Methods and results We screened 2,481 adults without known HF during a nationwide, community-based campaign held in 21 hospital cardiology centres across France. All participants underwent capillary NT-proBNP testing using a point-of-care assay. A threshold of >125 pg/mL, per ESC guidelines for ruling out HF in ambulatory settings, was exceeded in 419 individuals (16.9%), of whom 36.5% were asymptomatic. Conversely, 30.5% of those with NT-proBNP ≤125 pg/mL reported at least one symptom. Symptom-based screening alone had limited diagnostic accuracy for detecting NT-proBNP >125 pg/mL. The presence of ≥1 symptom yielded a sensitivity of 63.2% and a specificity of 42.4%. Dyspnoea was the most sensitive symptom (47.7%), while weight gain had the highest specificity (84.7%). In contrast, the absence of both symptoms and NT-proBNP elevation was associated with a high negative predictive value (85.4%). Among the 198 participants with NT-proBNP >125 pg/mL who underwent cardiologist-led evaluation, 40.9% were classified as symptomatic HF (Stage C), and 24.2% as preclinical HF (Stage B). Conclusion Combining symptom assessment with NT-proBNP testing improves early identification of at-risk individuals and may help uncover a significant proportion of undiagnosed or early-stage HF.