EARLY DETECTION OF HEART FAILURE IN PRIMARY CARE: EVALUATING A FRAILTY-BNP SCREENING PATHWAY FOR IMPROVED OUTCOMES- A NARRATIVE REVIEW

Abstract

Background: Heart failure (HF) affects an estimated 64 million individuals worldwide, contributing to a substantial global burden with annual mortality near 10%. Despite therapeutic advances, late recognition remains a barrier to optimal outcomes as many patients transition silently from asymptomatic ventricular dysfunction to overt HF. Integrating frailty assessment with B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) screening offers a feasible primary care strategy for identifying early cardiac dysfunction before symptomatic deterioration. This review aimed to determine whether integrating frailty assessment with BNP or NT-proBNP testing can enhance early HF diagnosis and reduce hospitalization burden in primary-care populations. Methods: This narrative review, conducted in accordance with PRISMA-Narrative reporting standards, synthesised evidence published between 2020 and 2025 from PubMed, Scopus, and Google Scholar, encompassing 18 core studies (observational cohorts, meta-analyses, and community-based screening programs). Studies evaluating frailty indices (Clinical Frailty Scale, Fried Phenotype, Edmonton Frail Scale) and BNP/NT-proBNP testing were examined for diagnostic accuracy, predictive value, hospitalization, cost-effectiveness, and system feasibility. Findings were contextualised within ESC (2023) and AHA (2025) preventive frameworks. Results: Frailty prevalence in preclinical or early HF ranged 25–35 %, correlating with a 2.3-fold increase in hospitalizations and 1.8-fold higher mortality. BNP and NT-proBNP showed pooled diagnostic sensitivity 90 % and specificity 85 % for asymptomatic LV dysfunction (AUC 0.88–0.93). Thresholds of BNP ≥ 35 pg/mL or NT-proBNP ≥ 125 pg/mL predicted transition to symptomatic HF. Integrated frailty plus BNP pathways improved new HF detection by ≈3-fold within 12 months, shortened time-to-diagnosis by 4–6 weeks, and reduced unnecessary echocardiography by 20 25 %. UK cost-models indicated 15–20 % diagnostic-expenditure savings through optimized triage and early therapy. Conclusion: Integrating frailty screening with natriuretic-peptide testing provides a statistically validated, cost-efficient framework for early HF detection in primary care. The combined approach enhances diagnostic precision, accelerates intervention, and may reduce hospital burden. Broader multicentre validation and global health-economic modelling are warranted to confirm long-term scalability and policy impact.