Risk reclassification and cost-effectiveness of echocardiography for cardiovascular primary prevention in hypertension in China.

OBJECTIVE

We aimed to assess risk reclassification and cost-effectiveness of echocardiography for cardiovascular primary prevention in hypertension.

METHODS AND

RESULTS

Community hypertensive patients without cardiovascular disease (CVD) were included from the 2016-2020 China PEACE Project (n = 3243). Discriminative performance of adding echocardiographic measures to conventional clinical model was assessed. Based on mean incidence rate of major adverse cardiovascular events (MACE), participants were classified into low-risk, intermediate-risk, and high-risk categories. Number needed to test (NNT) and cost of echocardiography for screening one intermediate-risk and one high-risk individual were calculated. After a median follow-up of 4.5-year, 368 participants (11.3% of the cohort) had MACE. Adding subclinical cardiac changes on echocardiography improved discriminative performance of conventional clinical model, with C-statistic increased by 0.028 (P-value = 0.003). Presence of subclinical cardiac changes led to reclassification of 18% of low-risk individuals into intermediate-risk and 4% into high-risk categories. Based on the differences in the rate of MACE between low-risk and intermediate-risk and high-risk groups, 77 (USD 3080) and 11 (USD 440) echocardiographic examinations were needed to identify one intermediate-risk and one high-risk individual respectively at the first-year follow-up. These numbers decreased to 27 (USD 1080) and 7 (USD 280) at the second-year follow-up; and further declined to 20 (USD 800) and 6 (USD 240) at the third-year follow-up. Echocardiography is cost-effective based on the monetary value of a quality-adjusted life year (USD 14 952).

CONCLUSION

The results demonstrate the potential of echocardiography for risk reclassification and cost-effectiveness in the context of cardiovascular primary prevention among hypertensive individuals in China.