To analyze the cost efficiency of guidelines proposed by the European Society of Cardiology for investigation of patients in the community with suspected
heart failure (HF). The guidelines recommend electrocardiography (ECG) and/or measurement of N-terminal pro
B type natriuretic peptide (
NTproBNP) prior to referral for echocardiography. Portable echocardiography is a new but validated technique for the evaluation of HF. Accordingly, 137 suspected HF patients (mean age 71+/-13 years) from the community underwent ECG and
NTproBNP estimation prior to portable echocardiography. Cost effective analysis for ECG,
NTproBNP, portable echocardiography and a combination of these; to define
valvular heart disease,
right ventricular dysfunction and left ventricular systolic and diastolic dysfunction were compared. The cost of abnormal
NTproBNP followed by portable echocardiography, abnormal ECG followed by portable echocardiography and portable echocardiography alone for the detection per case of
left ventricular systolic dysfunction were 313 euro, 310 euro, and 296 euro respectively and that for detection per case of any of the aforementioned cardiac abnormalities were 198 euro, 223 euro, and 170 euro respectively. Portable echocardiography alone for the assessment of suspected HF patients resulted in a cost reduction of up to 1083 euro for the detection per case of cardiac abnormality. While a strategy where initial
NTproBNP estimation is cost effective in detecting any causes of
heart failure, portable echocardiography remains the most costeffective strategy to assess patients from the community with suspected
heart failure.