SCReening Evaluation of the Evolution of New Heart Failure Study (SCREEN-HF): early detection of chronic heart failure in the workplace
Umberto Boffa A E , Michele McGrady B , Christopher M. Reid A , Louise Shiel A , Rory Wolfe A , Danny Liew A , Duncan J. Campbell C , Simon Stewart D and Henry Krum AA Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia. Email: C.Reid@monash.edu; louise.shiel@monash.edu; rory.wolfe@monash.edu
B Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia. Email: michelle.mcgrdy@centralsydneycardiology.com.au
C Department of Molecular Cardiology, St. Vincent’s Institute of Medical Research, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia. Email: dcampbell@svi.edu.au
D Australian Catholic University, Mary MacKillop Institute for Health Research, Level 5, 215 Spring Street, Melbourne, Vic. 3000, Australia. Email: simon.stewart@acu.edu.au
E Corresponding author. Email: dr.umberto.boffa@gmail.com
Australian Health Review 41(2) 121-126 https://doi.org/10.1071/AH15107
Submitted: 21 July 2015 Accepted: 8 March 2016 Published: 21 April 2016
Abstract
Objective The aim of the present study was to determine whether asymptomatic heart failure (HF) in the workplace is subject to the health worker effect, making screening using conventional risk factors combined with a cardiac biomarker, namely N-terminal pro B-type natriuretic peptide (NT-proBNP), as useful as in the general population.
Methods Between June 2007 and December 2009 a ‘well’ population deemed at high risk for development of HF was identified through health insurance records. Blood was collected from volunteer participants for analysis of urea, electrolytes and creatinine, a full blood count and NT-proBNP. An echocardiogram was performed on selected participants based on high NT-proBNP concentrations.
Results The mean left ventricular ejection fraction (LVEF) was significantly reduced in participants with the highest compared with the lowest NT-proBNP quintile. In multivariate analysis, log-transformed NT-proBNP was independently associated with impaired LVEF and with moderate to severe diastolic dysfunction after adjustment for age, sex, coronary artery disease, diabetes, hypertension and obesity.
Conclusions A large burden of asymptomatic left ventricular dysfunction (AVLD) was observed in subjects aged 60 and over with plasma NT-proBNP in the top quintile that was independent of conventional risk factors and work status. HWE does not appear to operate in AVLD. NT-proBNP testing in a population with HF risk factors may cost-effectively identify those at greatest risk of developing HF in a working population and facilitate early diagnosis, treatment and maintenance of work capacity.
What is known about the topic? Chronic heart failure (CHF) has several causes, the most common being hypertension and coronary ischaemia. CHF is a major health problem of increasing prevalence that severely impacts quality of life, shortens lives and reduces worker productivity. It is often not diagnosed early enough to take full advantage of ameliorating medication.
What does this paper add? Population screening for CHF is not currently advocated. This may be because conventional risk factors must be used in combination and there is no useful biomarker available. Yet evidence (SOLVD (Studies of Left Ventricular Dysfunction trials) recommends early diagnosis. We believe the work place is an area of potential screening where there is little supporting evidence. This paper provides evidence that the biomarker NT-proBNP is a useful new tool that improves cost-effectiveness of screening in a selected population. Specifically, the paper recommends CHF screening in the population with the highest potential health gain (i.e. the working population) by the sector with the highest economic gain (i.e. employers).
What are the implications for practitioners? The paper presents important health screening recommendations for medical and health and safety practitioners within a selected population of workers. We feel practitioners should consider screening for incipient heart failure, particularly within Australia’s working population, to save lives, provide economic benefit and extend working longevity.
Additional keywords: cardiac biomarkers, echocardiography, ventricular dysfunction.
References
[1] Davies MK, Hobbs FDR, et al Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet 2001; 358 439–44.| Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvmvVSqtQ%3D%3D&md5=024ec47e3ffe3ec894cb8a9ff7fd142dCAS |
[2] McGrady M, Krum H. Screening: the new frontier in heart failure management. Cardiovasc Ther 2009; 27 1–3.
| Screening: the new frontier in heart failure management.Crossref | GoogleScholarGoogle Scholar | 19207473PubMed |
[3] The SOLVD Investigators Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325 293–302.
| Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.Crossref | GoogleScholarGoogle Scholar | 2057034PubMed |
[4] Liu JL, et al The economic burden of coronary heart disease in the UK. Heart 2002; 88 597–603.
| The economic burden of coronary heart disease in the UK.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38XkslSgs7s%3D&md5=7b157644500406d88e24b965dac792fcCAS | 12433888PubMed |
[5] Halley CM, Houghtaling PL, Khalil MK, Thomas JD, Jaber WA. Mortality rate in patients with diastolic dysfunction and normal systolic function. Arch Intern Med 2011; 171 1082–7.
| 21709107PubMed |
[6] Pritchett AM, et al Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol 2005; 45 87–92.
| Diastolic dysfunction and left atrial volume: a population-based study.Crossref | GoogleScholarGoogle Scholar | 15629380PubMed |
[7] Shah D. Healthy worker effect phenomenon. Indian J Occup Environ Med 2009; 13 77–9.
| Healthy worker effect phenomenon.Crossref | GoogleScholarGoogle Scholar | 20386623PubMed |
[8] Baillargeon J. Characteristics of the healthy worker effect. Occup Med 2001; 16 359–66.
| 1:STN:280:DC%2BD3M3jtVOjug%3D%3D&md5=a224446cc3027febbbd5a3ac7a33ab68CAS | 11319057PubMed |
[9] World Health Organization (WHO). Global strategy on diet, physical activity and health. Geneva: WHO; 2004. Available at:http://www.who.int/dietphysicalactivity/en [verified 31 March 2016].
[10] Black C. Working for a healthier tomorrow: review of the health of Britain’s working-age population. 2008. Available at: http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf [verified 31 March 2016].
[11] Benedict MA, Arterburn D. Worksite-based weight loss programs: a systematic review of recent literature. Am J Health Promot 2008; 22 408–16.
| Worksite-based weight loss programs: a systematic review of recent literature.Crossref | GoogleScholarGoogle Scholar | 18677881PubMed |
[12] Tarride JE, et al Partnership in employee health. A workplace health program for British Columbia Public Service Agency (Canada). Work 2011; 40 459–71.
| 1:STN:280:DC%2BC38%2FjvVOktw%3D%3D&md5=8278f20f14135930b5ebd6ff041d60e6CAS | 22130063PubMed |
[13] Cancelliere C, et al Are workplace health promotion programs effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature. BMC Public Health 2011; 11 395
| Are workplace health promotion programs effective at improving presenteeism in workers? A systematic review and best evidence synthesis of the literature.Crossref | GoogleScholarGoogle Scholar | 21615940PubMed |
[14] Worksafe Victoria. Workhealth initiative. Available at: http://www.workhealth.vic.gov.au [verified 24 March 2016].
[15] SOLVD Investigators Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 2002; 375 685
[16] McGrady M, Reid CM, Shiel L, Wolfe R, Boffa U, Liew D, Campbell DJ, Prior D, Krum H. N-Terminal B-type natriuretic peptide and the association with left ventricular diastolic function in a population at high risk of incident heart failure: results of the SCReening Evaluation of the Evolution of New-Heart Failure Study (SCREEN-HF). Eur J Heart Fail 2013; 15 573–80.
| N-Terminal B-type natriuretic peptide and the association with left ventricular diastolic function in a population at high risk of incident heart failure: results of the SCReening Evaluation of the Evolution of New-Heart Failure Study (SCREEN-HF).Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXmtlequr8%3D&md5=a730972a14c4dc302895a3e99769a730CAS | 23338855PubMed |
[17] Leupker RV, Evan A, McKeigue P, Reddy K. Cardiovascular survey methods, 3rd edn. Geneva: World Health Organization. 2004.
[18] Kligfield P, Gettes LS, et al Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2007; 49 1109–27.
| Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology.Crossref | GoogleScholarGoogle Scholar | 17349896PubMed |
[19] Mason JW, Hancock EW, et al Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2007; 49 1128–35.
| Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology.Crossref | GoogleScholarGoogle Scholar | 17349897PubMed |
[20] Gottdiener J, Bednarz J, et al American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004; 17 1086–119.
| American Society of Echocardiography recommendations for use of echocardiography in clinical trials.Crossref | GoogleScholarGoogle Scholar | 15452478PubMed |
[21] Zoghbi WA, Enriiquez-Sarano M, et al Recommendations for evaluation of the severity of native valve regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16 777–802.
| Recommendations for evaluation of the severity of native valve regurgitation with two-dimensional and Doppler echocardiography.Crossref | GoogleScholarGoogle Scholar | 12835667PubMed |
[22] Lin LI-K. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45 255–68.
| A concordance correlation coefficient to evaluate reproducibility.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1M3kslKrtg%3D%3D&md5=8831aa6a8cd83e7d3b1a951adbd807ccCAS |
[23] McDonagh TA, Robb SD, et al Biochemical detection of the left ventricular systolic dysfunction. Lancet 1998; 351 9–13.
| Biochemical detection of the left ventricular systolic dysfunction.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FpsFSjtQ%3D%3D&md5=aa61b0612cf41b7e8d6b5b146ac57538CAS | 9433422PubMed |
[24] Hobbs F, Davis R, et al Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community population. BMJ 2002; 324 1498–500.
| Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community population.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zjtlKmug%3D%3D&md5=b385c8e05db3c3083ccf8d21f31fff08CAS | 12077039PubMed |
[25] Porapakkham P, Porapakkham P, et al B-Type natriuretic peptide-guided heart failure therapy: a meta-analysis. Arch Intern Med 2010; 170 507–14.
| B-Type natriuretic peptide-guided heart failure therapy: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXksFSqsbo%3D&md5=ee4cef96c90863f1a46e37e759f805edCAS | 20308637PubMed |
[26] Betti I, Castelli G, et al The role of N-terminal pro-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail 2009; 15 377–84.
| The role of N-terminal pro-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXms1ygsrY%3D&md5=d65fbe3e3056214e6062a61f5c6c25c2CAS | 19477397PubMed |
[27] Cowie MR. The global burden of heart failure. Presented at Heart Failure Conference, Seville, Spain 23–26 May 2015.
[28] Nielsen OW, McDonagh TA, Robb SD, Dargie HJ. Retrospective analysis of the cost-effectiveness of using plasma natriuretic peptide in screening for left ventricular systolic dysfunction in the general population. J Am Coll Cardiol 2003; 41 113–20.
| Retrospective analysis of the cost-effectiveness of using plasma natriuretic peptide in screening for left ventricular systolic dysfunction in the general population.Crossref | GoogleScholarGoogle Scholar | 12570953PubMed |
