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.
Keywords:
Clinical symptoms; Heart failure screening; NT-proBNP; Primary care.
