Early detection of heart failure remains a notable clinical challenge, often because initial symptoms can be subtle or easily mistaken for other conditions. Recognizing this difficulty, researchers have been exploring innovative strategies to identify individuals at risk before the condition progresses. This article delves into a two-step screening approach – combining a symptom questionnaire with a simple blood test – designed to improve the early identification of both elevated cardiovascular risk and preclinical heart failure.
Understanding the Challenge of Heart Failure Screening
heart failure doesn’t always present with dramatic symptoms. In fact, many people experience a gradual decline in function, making early diagnosis difficult. As of late 2025, the American Heart Association estimates that over 6.2 million adults in the United States are living with heart failure, and nearly one in five are unaware they have the condition.This underscores the critical need for proactive screening methods.
The Two-Step Screening Strategy: EPOF and NT-proBNP
A recent study conducted across 21 hospital cardiology centers in France evaluated a novel screening strategy. This approach utilizes two key components: a symptom-based questionnaire, utilizing the acronym EPOF (dyspnoea, weight gain, oedema, fatigue – in French), and a capillary NT-proBNP fingerstick test.
Let’s break down each element:
* EPOF Questionnaire: This questionnaire focuses on four common symptoms associated with heart failure. It’s designed to be speedy and easy for individuals to complete, providing a preliminary assessment of their risk.
* NT-proBNP Testing: NT-proBNP is a hormone released by the heart in response to stress. Elevated levels can indicate heart strain, even before symptoms become apparent. The test involves a simple fingerstick blood sample,offering a convenient and minimally invasive assessment.
Researchers screened 2,481 adults without a prior diagnosis of heart failure. Participants underwent capillary NT-proBNP testing, with a threshold of >125 pg/mL – consistent with European Society of Cardiology (ESC) guidelines for ruling out heart failure in outpatient settings – used to identify those requiring further evaluation.
Key Findings from the French Study
The results revealed some compelling insights.Approximately 16.9% of the participants (419 individuals) had NT-proBNP levels exceeding the 125 pg/mL threshold.Interestingly, over a third (36.5%) of these individuals were completely asymptomatic. This highlights a crucial point: heart failure can be present even without noticeable symptoms.
Conversely, more than 30% of those with normal NT-proBNP levels did report experiencing at least one symptom. this suggests that symptom-based screening alone has limitations.
Analyzing the individual symptoms, dyspnoea (shortness of breath) proved to be the most sensitive indicator (47.7%), while weight gain demonstrated the highest specificity (84.7%). However, the absence of both symptoms and elevated NT-proBNP levels was a strong predictor of a low risk, with a high negative predictive value of 85.4%.
Further cardiologist-led evaluations of the 198 participants with elevated NT-proBNP levels classified 40.9% as having symptomatic heart failure (Stage C) and 24.2% as having preclinical heart failure (Stage B).
The Power of Combined Assessment for Heart Failure Screening
The study’s conclusion is clear: combining symptom assessment with NT-proBNP testing significantly improves the early identification of