Congestive Heart Failure: Heart failure more prevalent in PAD patients, cost-effective to screen
The presence of peripheral arterial disease (PAD) is associated with a nearly two-fold increase in the prevalence of heart failure (HF) which might serve to enhance the cost-effectiveness of general screening criteria for the underlying detection of HF, according to the November/December 2007 issue of Congestive Heart Failure.

Rishi G. Anand, MD, of the Louisiana State University School of Medicine in New Orleans, and colleagues, underwent the study to perform a systematic review using meta-analysis to ascertain the prevalence of HF among patients with PAD.

A detailed computerized search in MEDLINE (1966–2003) was performed to find studies that addressed PAD of the lower extremities, the researchers said. The search was limited to published trials with human participants who spoke English and with a patient enrollment age older than 19 years.

The seven studies that met inclusion criteria included 10,205 patients for analysis. The entire study population had a mean age of 67 years. Only one study delineated prevalence of HF with respect to sex. Five studies were performed in the United States and one study was performed in France.

All studies had a higher prevalence of HF than age- and sex-matched expected prevalence rates for HF as determined by National Health and Nutrition Examination Survey (NHANES). The mean prevalence of HF in patients with PAD was 7.3 percent compared with an expected population prevalence based on clinical score of 4.1 percent.

Based on the results of the study, 32 patients with PAD needed to be screened to detect one case of clinically apparent HF, the researchers said. In comparison, the number needed to screen using mammography to detect one case of breast cancer is 1792 (for women older than 50). Therefore, using PAD as a risk marker to enhance HF screening appears to be worthwhile when compared with a nationally accepted screening tool.

A cost-effective screening strategy that adequately identifies patients with clinically silent ventricular dysfunction has yet to be developed, according to researchers. A recent study by Heidenreich and associates suggests that B-type natriuretic peptide testing followed by echocardiography is likely to be a cost-effective screening strategy for men aged 60 years and possibly for women when at least a 1 percent prevalence of moderate or greater left ventricular systolic dysfunction exists. The cost effectiveness increases even further with populations where the estimated prevalence of heart failure is even greater than 1 percent.

As a result of their findings, the researchers contend that the strategies that use PAD as a potent risk marker for underlying HF can enhance the cost-effectiveness through general screening criteria.